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General  Plan  of  the  Circulation 


A  MANUAL   OF   INSTRUCTION 

IN^   THE    PRINCIPLES   OF 

PROMPT  AID  TO  THE  INJURED 

mCLUDIKG  A  CHAPTER   ON   HYGIENE 
AND   DISINFECTION 

DESIGNED  FOR  CIVIL  AND  MILITARY  USE 


BY 

ALVAH   H.   DOTY,  M.D. 

LATE  HEALTH   OFFICER  OF  THE  PORT  OF  NEW  YORK 
LATE  MAJOR  AND  SURGEON,  NINTH  REGIMENT,  N.  G.  N.  Y. 


FIFTH  EDITION 


NEW    YORK    AND    LONDON 

D.    APPLETON    AND    COMPANY 

1913 


Copyright,  1889, 1894, 1898, 1902, 1912, 
By  D.   APPLETOX  AND   COMPANY 


J3  74 


Printed  in  the  United  States  of  America 


*h 


ip 

P  TO 

JOSEPH  D.  BRYANT,  M.  D., 

P^  IN    ACKNOWLEDGMENT    OF    HIS    HIGH    POSITION 


AS  A  TEACHER  OF  ANATOMY  AND  SURGERY, 

AND   AS   A   LUCID   WRITER 

AND   EXPONENT   OF   THEIR   PRACTICAL   APPLICATION^ 

TRIB  MANUAL  IS  DEDICATED 

BY  THE   AUTHOR, 


PREFACE   TO   FIFTH  EDITION. 


The  fifth  edition  of  this  book  has  been  prepared  to 
meet  the  needs  of  the  more  advanced  knowledge  in  medi- 
cine and  snrgery  and  also  to  conform  more  closely  to  the 
principles  of  modern  sanitation.  Every  effort  has  been 
made  to  introduce  material  which  shall  be  of  practical 
importance  in  connection  with  these  subjects  with  the 
intent  to  make  the  book  of  special  value,  not  only  for 
home  use  but  also  in  mining  districts,  manufactories  and 
other  places  where  many  persons  are  brought  together 
and  where  accidents  frequently  occur. 

Alvah  H.  Doty,  M.  D. 

New  York  City. 


CONTENTS. 


CHAPTER    I. 

PAGE 

Bone-  .........       1 

Boxi<> :  its  composition  and  function — Periosteum  and  en- 
dosteum — Classification  of  bone — Tlie  slieleton — Spine — 
Bony  landmarljs — Slsull — Hyoid  bone — Ttiorax — Stex'num 
and  ribs — Scapula — Clavicle — Bones  of  upper  extremity — 
Pelvis — Bones    of   lower    extremity. 

CHAPTER    II. 

Joints — Cartilage — Ligaments — Synovial     Membrane — Mus-     ' 
CLES  .........      23 

Joints  :  their  classification  and  movement — Cartilage — 
Ligaments — Synovial  Membrane — Muscles — Tendons  and 
aponeuroses — Definition  of  organs — Glands — Mucous  and 
serous  membrane — Excretion  and  secretion. 

CHAPTER    III. 

The  Blood  and  Circulatory  Organs    .  .  .  .  .30 

Blood  :  its  composition  and  function — Heart — Pericardium 
— Circulation    of    the    blood — Endocardium — Blood-vessels. 

CHAPTER     IV. 

Respiratory   Apparatus   and   Respiration    .  .  .  .39 

Definition  of  respiration  —  Larynx  —  Trachea — Bronchial 
tubes — Lungs. 

CHAPTER    V. 

Alimentation   and   Digestion      ......     45 

Alimentary  tract — Mastication — Teetli — Salivary  glands — 
Pharynx — CEsophagus — Stomach — Small  and  large  intes- 
tine— Liver — Pancreas. 

ix 


X  CONTENTS. 

CHAPTER    VI. 

PAGB 

Kidneys — Bladder — Skix — Spleen         .  .  .  .  .54 

CHAPTER    VII. 

Neevous    System  .  .  .  .  .  .  .  .      59 

Cerebro-spinal  sj-stem  —  Brain  —  Cerebrum — Cerebellum — 
Pons  Varolii — Medulla  oblongata — Spinal  cord — Cranial 
and  spinal  nerves — Sympathetic  system. 

CHAPTER    VIII. 

Bandages,   Dressings,  etc.  .  .  .  .  .  .68 

Bandages :  their  classification — Material  for  construction 
— Methods  of  application — Roller,  Esmarch,  or  handker- 
chief bandages  —  Slings — Knots — Compresses — Tampons — 
Poultices— Moist  and  dry  heat. 

CHAPTER    IX. 

Contusions   and   Wounds    ....,•..     91 
Classification   and   treatment. 

CHAPTER    X. 

HEMORRHAGE  ......  o  .  .     104 

Haemorrhage — Arterial— Venous — Capillary — Means  of  ar- 
resting hsemorrhage,  and  how  applied. 

CHAPTER    XI. 

Fractures     .........  120 

Fractures  :  their  classification — Signs  of  fracture — Method 
of  repair  by  Nature — Treatment  of  special  fracture — Dis- 
locations— Sprains. 

CHAPTER    XII. 

Burns,  Scalds,  and  Frost-bite    ......   140 

Burns  and  scalds  :  their  classification — Treatment  of  each 
degree — Frost-bite,    and   its   treatment. 

CHAPTER    XIII. 

Unconsciousness,  Shock  or  Collapse,  and  Syncope   .  .  146 

Definition  of,   and  treatment. 


CONTENTS.  Xi 

CIIArTER    XIV. 

PAGE 

Concussion  and  Compression   of  the   Brain — Apoplexy,   or 
Stroke   ok   I'akalysis— Int(jxication — Epilepsy,    Hys- 
teria,  AND   Heatstroke  or  Sunstroke        .  .  .    154 
Definition  of,  and  treatment. 

CHAPTER    XV. 

Asphyxia   and   Drowning    .......   164 

Asphyxia,  or  suffocation — Treatment — rrevention — Drown- 
ing— Artificial  respiration — Different  methods — Sylvester's, 
Howard's,  and  Hall's. 

CHAPTER    XVI. 

Medication        .  .  .  .  .  .  .  .  .   172 

CHAPTER    XVII. 
Poisons    and    Poisoning      .......   176 

Varieties  of  poisons — Narcotics,  irritants,  and  corrosives — 
Antidotes  and  treatment. 

CHAPTER    XVIII. 

Convulsion  op  Children — Tetanus — Foreign  Bodies  in  Eye, 
Ear,  Nose,  Larynx,  and  Pharynx — Foot-soreness  and 
Chafing  ......'..   189 

CHAPTER    XIX. 
Hygiene       ..........    197 

Baths — Clothing — Food — Water — Air — Exercise. 

CHAPTER    XX. 

Disinfection       .........   214 

Definition — Sulphurous  acid  gas — Formaldehyde  gas — Bi- 
chloride   of   mercury — Special    disinfection. 


ILLUSTRATIONS. 


FIGUEE  PAGE 

28.  Abdominal    contents,    position    of Flint.  50 

24.  Air-cells  and   terminal   bronchial   tubes Flint.  43 

G6.  Arteries,   diagram   showing  position   of  important. 

Pije,  modified.     Face  109 

70.  Artery,   brachial,   digital   compression  of Esmarch.  115 

69.  Artery,    brachial,    line    showing    course    of Tracy.  114 

GT.  Artery,    common   carotid,   digital    compression  of. 

Esmarch,  modified.  112 

73.  Artery,  femoral,  compression    by    tourniquet.  .      Esmarch.  118 

72.  Artery,   femoral,   digital   compression   of Esmarch.  117 

71.  Artery,   femoral,   line  ..showing  course  of Tracy.  116 

68.  Artery,  subclavian,   digital   compression  of. 

Esmarch,   modified.  113 

84.  Artificial   respiration :   Hall's    method :    first    position. 

Original.  171 

85.  Artificial  respiration :  Hall's    method  ;    second    position. 

Original.  171 

82.  Artificial  respiration  :  Howard's  method  ;    first    part. 

Original.  169 

83.  Artificial  respiration  :  Howard's  method  :  second  part. 

Original.  170 

80.  Artificial  respi*ation  :  Sylvester's  method  ;  first 

movement     Original.  168 

81.  Artificial  respiration  :   Sylvester's  method  ;  sec- 

ond   movement    Original.  168 

58.  Bandages,  cravat,   for  Land Esmarch,    modified.  84 

59.  Bandages,  cravat,    for    Itnee Esmarch.  84 

44.  Bandages,    four-tailed,    for    head Esmarch.  75 

43.  Bandages,  four-tailed,    for    jaw Original.  75 

39.  Bandages,  method   of   rolling. 

Reference  Hand-hooTc  of  Medical  Sciences.  69 

42.  Bandages,     knotted Esmarch.  74 

4.J,    46.  Bandages,    large  square   handkerchief..      Esmarch.     76,    77 
41.  Bandages,   spica  of  shoulder. 

Reference   Hand-hooJc   of   Medical   Sciences.  73 

40.  Bandages,    spiral   reverse. 

Reference   Hand-hook   of   Medical   Sciences.  71 
xiii 


XIV  ILLUSTRATIONS. 

IIGFEE  PAGE 

47.  Bandages,    triangular,    diagram 77 

51.  Bandages,   triangular,   for   chest,   etc,     Esmarch,   modified.  80 
57.  Bandages,  triangular,  for  foot Esmarch,  modified.  83 

48,  40.  Bandages,   triangular,   :&or  head..      Esmarch,   modified.  78 

56.  Bandages,    triangular,   for   hip Esmarch,    modified.  83 

50.  Bandages,   triangular,  for  shoulder,   hand,   etc. 

Esmarch,    modified.  79 

52.  Bandages,    triangular,    for    shoulder,    head,    etc. 

Esmarch,    modified.  80 
1.  Bone,   cancellous  and  compact  tissue,   arrangement  of. 

Tracy.  2 

33.  Brain    inclosed    in    membranes Didama.  59 

35.  Brain,    under    surface    of Tracy.  61 

36.  Brain,    upper    surface    of Didama.  62 

37.  Brain    and    spinal    cord Tracy.  65 

0.  Clavicle     (collar-bone) Original.  14 

75.  Clavicle,    dressing   for   fracture    of Pye,    modified.  129 

18.  Corpuscles  of  human  blood,  red  and  white Flint.  31 

76.  Femur,   fracture  of ;   gun  used   for  temporary   splint. 

Esmarch,  modified.  133 

13.  Femur    (thigh-bone)     Original.  19 

15,  Foot,    bones    of    ;  .      Original.  21 

11.  Forearm   (radius  and  ulna),  bones  of Original.  16 

21.  Frog's    foot,    web    of,    magnified Flint.  37 

12.  Hand,    bones    of , Original.  17 

19.  Heart     Didama.  32 

20.  Heart    and    ribs,    relation    of Flint.  33 

10.  Humerus    (arm-bone)     Original.  15 

25.  Jaws   and   teeth Didama.  46 

31.  Kidney,    vertical    section    of Flint.  55 

77.  Knot,    Gerdy's    extension 134 

63.  Knot,    granny    Bryant.  85 

62.  Knot,    granny,    handkerchief Esmarch.  85 

60.  Knot,    reef    Bryant.  85 

61.  Knot,    reef,    handkerchief Esmarch.  85 

64.  Knot,    surgeon's     Bryant.  86 

14.  Leg,    bones    of Original.  20 

79.  Leg,   fracture  of  :   pillow  for  temporary   splint.     Original.  136 

78.  Leg,  fracture  of  ;  umbrella  for  temporary  splint.  Original.  135 

29.  Liver     Tracy.  51 

17.  Muscular    system    Tracy.  26 

34.  Nerves,    cerebro-spinal   system    Tracy.  60 

38.  Nerves,    sympathetic   system    Tracy.  66 

30.  Pancreas    (sweet-breads)    Tracy.  53 

16.  Patella    (knee-cap)     Original.  22 

7.  Rib,    a    Original.  12 

26.  Salivary  glands    Tracy.  47 

8.  Scapula     ( shoulder-blade)     Original.  13 


ILLUSTRATIONS.  XV 

FIGURE  PAGE 

2.  Skeleton     Tracy.  5 

32.   Skin,    vertical    section    of    Didamu.  50 

4.  Skull     Original.  9 

74.  Sling,  skirt  of  coat  used  as  a Esmarch,  modified.  124 

53.  Slings,  triangular,  for  arm Esmarch,  modified.  81 

54.  Slings,    triangular,    for   arm Esmarch,    modified.  81 

55.  Slings,    triangular,   for  arm Esmarch,   modified.  82 

3.  Spine,    vertical    section    of Tracy.  6 

27.  Stomach     Didama.  48 

65.  Suspender,    Esmarch's    Oriyinal.  108 

5.  Thorax     (chest),    anterior    view Sappey.  10 

6.  Thorax    (chest),    posterior    view Sappey.  11 

23.  Thorax    (chest),   cavity  of,   showing  position  of 

heart   and    lungs    Didama.  41 

22.  Trachea    and    bronchial    tubes Sapper/.  40 


PROMPT   AID   TO   THE   INJURED. 


CHAPTER  I. 
BONE. 

Bone  is  composed  of  animal  and  earthy  matter ;  the 
former  consists  chiefly  of  a  material  which  is  converted  by 
boiling-  into  gelatin,  also  fat  and  blood-vessels  ;  the  lat- 
ter, known  as  "bone-earth,"  is  composed  principally  of 
phosphate  of  lime.  Bone  derives  its  tenacity  and  elas- 
ticity from  the  animal  portion,  and  the  "  bone-earth  "  gives 
to  it  the  necessary  hardness. 

When  soup  is  made  by  boiling  a  bone,  there  is  simply 
a  liberation  of  the  gelatin  or  animal  matter;  the  latter 
may  be  extracted,  by  boiling,  from  bone  two  or  three 
thousand  years  old.  In  early  life  the  animal  part  forms 
about  one  third  and  the  earthy  matter  two  thirds  of  bone ; 
later  in  life,  however,  the  proportion  of  phosphate  of  lime 
is  somewhat  increased,  and  the  bone  also  becomes  denser. 
This  will  explain  why  the  bones  of  children  are  so  elastic 
that,  when  considerable  force  is  applied,  they  are  apt  to 
bend,  like  a  green  stick,  rather  than  break,  as  in  the  adult 
bone  under  similar  circumstances. 

Rickets  is  a  disease  of  childhood  representing  a  dimin- 
ished amount  of  earthy  matter ;  in  this  condition  the  bones 
become  bent  and  distorted,  the  deformities  being  partic- 
ularly marked  in  the  bones  of  the  lower  extremity,  and  in 
the  pelvis  and  chest. 
3 


PROMPT   AID   TO   THE   INJURED. 


A  section  of  bone  (Fig.  1)  shows  it  to  be  composed  of 
two  kinds  of  tissue — compact,  which  is  exceedingly  dense 
and  hard  like  ivory;  and  cancellated  or  "spongy"  bone, 

which  is  a  network  of  thin  plates 
and  columns  of  bone.  The  com- 
pact  tissue  constitutes  the  outer  por- 
tion of  bone,  and  is  very  much  in- 
creased where  great  strength  is  re- 
quired, as  in  the  shaft  of  the  femur 
or  "  thigh-bone."  The  cancellated 
tissue  is  internal,  and  especially 
abundant  where  bone  expands  to 
form  large  surfaces  for  support,  as 
in  the  extreinities  of  the  bones  of 
the  thigh,  legs,  etc.  Cancellated 
tissue  is  not  only  very  light,  but 
very  strong  ;  a  portion,  correspond- 
ing in  size  and  shape  to  a  piece  of 
loaf  or  cut  sugar,  will  support  a 
weight  of  three  or  four  hundred 
pounds,  while  a  square  inch  of  com- 
pact tissue,  about  one  half  inch  in 
thickness,  will  support  a  weight  of 
five  thousand  pounds.  Bone  is 
twice  the  strength  of  oak. 

In  the  skull,  where  great  strength 
is  necessary  to  support  and  protect 
the  brain,  we  find  two  layers  of  com- 
pact tissue  :  the  external  portion, 
known  as  the  "  outer "  table,  and 
the  internal  as  the  "inner"  table, 
with  a  small  amount  of  cancellated 
tissue,  known  as  the  diploe,  existing  between  them. 

The  long  bones  are  hollow.  This  condition  admits  of 
the  proper  length,  diameter,  and  strength,  while  it  greatly 
diminishes  the  weight. 

Tlie  "  medullary  "  or  "  hollow  canal "  in  the  shaft,  and 


Pie.  1.— The  right  femur,  or 
thigh-bone,  sawn  in  two 
lengthwise.  Showing  ar- 
rangement of  compact 
and  cancellous  tissues. 


BONE.  3 

the  cancellated  tissue  of  the  extremities  of  long  bones,  also 
the  cancellated  tissue  of  other  bones  throughout  the  body, 
contains  a  substance  called  marrow  or  "oil  of  bone."  In 
the  medullary  canal  it  is  called  yellow  marrow,  and  is 
composed  of  about  ninety-six  per  cent  of  fat,  while  the 
"red  marrow,"  which  is  found  in  cancellated  tissue,  is 
three  fourths  water  and  contains  but  a  trace  of  fat.  The 
medullary  canals  in  the  bones  of  birds  communicate  with 
the  lungs  and  contain  air  instead  of  marrow,  thereby  ren- 
dering" them  very  light  and  properly  adapted  for  flight. 

Bone  is  supplied  with  nutrition  from  two  sources ;  the 
periosteum^  and  the  nutrient  arteries.  The  periosteum  is 
a  fii'm  and  resisting  fibrous  membrane,  pinkish  in  color, 
which  is  adherent  to  the  bone,  and  covers  it  at  all  points 
except  where  cartilage  exists.  This  membrane  is  a  struct- 
ure in  which  blood-vessels  divide,  subdivide,  and  pass  into 
minute  openings  in  the  compact  tissue,  supplying  it  with 
nutrition.  The  cancellated  tissue  and  medulla  receive 
their  nutrition  from  larger  vessels  (nutrient  arteries), 
w^hicli  are  branches  of  the  main  arteries  in  the  vicinity  of 
the  bone,  and  pass  through  the  compact  tissue  to  their  des- 
tination. When  the  periosteum  is  removed  from  the  bone, 
the  compact  tissue  is  deprived  of  its  principal  means  of 
nutrition,  and  death  or  "  necrosis  "  (corresponding  to  gan- 
grene in  soft  tissues)  is  apt  to  ensue.  This  may  happen  in 
disease,  or  as  the  result  of  an  injury,  jDarticularly  to  super- 
ficial bones  such  as  the  tibia,  bones  of  the  head,  etc.  A 
familiar  example  is  a  "  felon,"  which  demands  immediate 
and  special  treatment  at  the  hands  of  the  surgeon. 

When  bone  is  in  the  normal  condition  and  properly 
covered  with  periosteum,  it  feels  smooth  and  moist,  and 
when  struck  with  a  probe  it  gives  a  dull  sound  ;  but  when 
the  periosteum  is  removed,  it  feels  rough  and  hard,  and 
striking  it  with  a  probe  produces  a  metallic  sound.  It  is 
important  to  the  surgeon  to  recognize  these  different  condi- 
tions, and  be  thus  easily  enabled  to  decide  whether  the 
periosteum  is  present  or  absent. 


4  PROMPT   AID   TO   THE   IXJURED. 

The  endosteum  is  a  tliin,  fragile  membrane  wliicli  cor- 
responds in  nutritive  function  to  tlie  periosteum,  and  lines 
the  medullary  canal  in  the  long  bones. 

Bones  are  supplied  with  nerv^es  and  lymphatics  or  ab- 
sorbents. 

The  lymphatics  have  been  known  to  remove  by  ab- 
sorption ivory  pegs  used  to  hold  in  place  the  broken  ends 
of  a  bone  which  would  not  unite  by  the  natui'al  process. 

The  shape  of  a  bone  depends  upon  the  function  it  per- 
forms. Bones  ai'e  divided  into  long^  short,  flat,  and  ir- 
regular. The  long  bones,  of  which  the  femur  or  ''thigh- 
bone "  is  a  type,  are  composed  of  a  shaft  and  two  extremi- 
ties, and.  with  their  muscular  attachments,  act  as  levers, 
and  also  for  support.  The  short  bones  are  found  where  a 
number  of  joints  are  required  for  limited  motion  com- 
bined with  strength.  An  example  of  this  class  is  the 
carpus  or  wiist. 

The  flat  bones  are  used  in  the  construction  of  cavities 
and  to  protect  their  contents,  and  are  also  for  muscular 
attachment,  as  the  bones  of  the  skull,  the  shoulder-blades 
(scapulgei.  etc. 

Examples  of  the  irregular  bones  are  the  upper  and  lower 
jaw  (superior  and  inferior  maxillary),  and  the  vertebrae. 

The  skeleton  (Fig.  2),  which  represents  the  bones  in 
their  prox)er  relations,  is  the  framework  to  which  the  soft 
structui'es  of  the  body  ai'e  attached.  It  consists  of  a  cen- 
tral column  (the  spine) ;  four  extremities  :  two  upper  (the 
arms),  and  two  lower  (the  legs);  and  three  bony  cavities: 
(1)  the  cranium  or  skull,  containing  the  brain  ;  (2)  the 
thorax  or  chest,  containing  the  heart  and  lungs  ;  and  (3) 
the  iDelvis  or  basin,  containing  the  pelvic  and  some  of  the 
abdominal  organs. 

The  skeleton  is  comi^osed  of  two  hundred  bones.  There 
are  several  small  bones  found  in  the  tendons  of  muscles, 
at  the  union  of  the  skull-bones,  and  also  in  the  eai%  which 
are  not  included  in  this  enumeration.  This  number  is 
divided  in  the  following  manner  : 


Fig.  2.— The  skeleton. 


PKOMPT   AID   TO   THE  INJURED. 

The  spine  or  vertebral  column.. ,....,  26 

Cranium S 

Face 14 

Os  hyoides,  sternum,  and  ribs ,  26 

Upper  extremities 64 

Lower  extremities 62 


The  spine  (Fig.  3),  wliicli  is  about 
one  third  the  length  of  the  body,  is  a 
jointed  column  consisting  of  a  series 
of  bones  (vertebrae)  articulated  or 
joined  together,  forming  three  slight 
curves.  It  supports  the  skull  and  its 
contents,  and  protects  the  spinal  cord, 
which  is  contained  in  a  canal  formed 
by  the  union  of  the  bony  parts.  At 
its  base  the  column  rests  upon  the 
upper  ]3ortion  of  the  pelvis — betv^^een 
the  "haunch-bones." 

A  vertebra  consists  of  two  impor- 
tant parts — a  body,  in  front,  and  a 
posterior  portion  or  vertebral  arch. 
The  bodies  are  piled  one  upon  the 
other  for  support  and  strength,  the 
arch  behind  forming,  by  its  junction 
with  the  body,  a  canal  for  the  passage 
of  the  spinal  cord.  Between  the  bod- 
ies of  the  vertebrae  are  found  layers 
or  pads  of  a  very  elastic  and  flexible 
substance,  known  as  "  intervertebral 
cartilage,"  which  forms  a  soft  cush- 
ion for  each  vertebra  to  rest  upon. 
Its  elasticity  prevents  or  diminishes  shock,  and  also  tends 
to  restore  the  column  to  its  erect  position.  Continued 
pressure  on  this  substance  during  the  day  diminishes  its 
thickness,  consequently  a  person  will  lose  about  half  an 


»^^^\ 


Fig.  3. — The  spine,  sawii 
in  two  lengthwise. 


BONE.  7 

inch  in  height  during  this  period ;  the  rest  and  recum- 
bent position  of  the  night  restore  it  to  its  previous  condi- 
tion. 

It  is  important  to  remember  that  leaning  too  much 
on  one  side,  as  at  a  desk,  will  cause  a  permanent  change 
in  the  cartilage,  so  that  the  vertebral  column  may  be  ab- 
normally bent  to  one  side  without  the  bone  being  primarily 
involved. 

The  curves  in  the  vertebral  column  assist  in  forming 
cavities  for  the  reception  of  important  organs.  It  is  said 
that  the  curves  increase  the  strength  of  the  column  ten- 
fold ;  they  also  aid  in  destroying  shock. 

The  twenty-six  bones  comprising  the  vertebral  column 
are  divided  in  the  following  manner,  viz. : 

Cervical  or  neck 7 

Dorsal  or  back 12 

Lumbar  or  loins 5 

The  sacrum,  which  represents  five  vertebrae  (in  fcetal 

life)  fused  into  a  single  bone 1 

The  coccyx  or  "  crupper,"  which  is  formed  from  four 

bones 1 

26 

The  freest  movement  in  the  vertebral  column  is  found 
in  the  neck  or  cervical  region,  and  the  least  movement  in 
the  back,  between  the  shoulders,  the  spine  here  being  con- 
nected with  the  ribs.  The  weakest  part  of  the  spine  is  at 
the  last  dorsal  vertebra,  and  this  portion  of  the  vertebral 
column  is  very  movable. 

It  is  very  essential  to  know  that  different  elevations  on 
the  surface  of  the  body  (bony  prominences,  etc.)  indicate 
the  situation  of  certain  important  internal  organs  ;  thus 
the  vertebral  column  furnishes  valuable  information. 
Rubbing  the  fingers  briskly  up  and  down  the  spine  will 
produce  sufficient  friction  to  redden  the  skin  over  the  bony 
prominences  known  as  "spinous  processes."  These  pro- 
cesses are  formed  by  the  union  posteriorly  of  the  sides  of 


g  PROMPT  AID   TO   THE   INJURED. 

the  vertebral  arches  abeady  spoken  of.  With  the  body- 
bent  forward  and  the  arms  folded  across  the  chest,  the 
spinous  processes  can  be  made  even  more  apparent. 

The  spinous  process  of  the  seventh  or  lowest  cervical 
vertebra  is  particularly  prominent,  and  has  received  the 
name  of  "vertebra  prominens,"  and  should  be  carefully 
sought  for,  as  it  will  aid  in  locating  others. 

The  lower  or  inferior  angle  of  the  scapula  or  "  shoulder- 
blade  "''  is  on  a  level  with  the  interval  between  the  seventh 
and  eighth  dorsal  vertebra?. 

Having  located  the  spinous  processes  of  the  different 
vertebrae,  the  following  points  are  to  be  remembered,  viz. : 

Interval  between  Sixth  and  Seventh  Cervical  Spines. 
— (Esophagus  and  trachea  begin. 

Seventh  Cervical. — Apex  or  upper  part  of  lung ;  con- 
sequently a  knife,  or  bullet  wound,  above  this  line,  unless 
carried  downward,  would  not  injure  the  lung. 

Third  Dorsal. — Upper  border  of  arch  of  aorta. 

Fourth  Dorsal. — Arch  of  aorta  ends  ;  upper  level  of 
heart ;  division  of  trachea  into  two  portions  ;  right  and 
left  bronchus. 

Eighth  Dorsal. — Left  side,  lower  level  of  heart. 

Ninth  Dorsal. — Left  side,  lower  end  of  oesophagus, 
passing  through  diaphragm ;  upper  or  cardiac  opening 
of  stomach  and  upper  edge  of  spleen. 

Tenth  Dorsal. — Left  side,  lower  level  of  lung. 

First  Lumbar. — About  the  middle  of  kidneys  ;  lower 
edge  of  spleen. 

The  skull  (Fig.  4)  is  the  case  for  the  lodgment  and  pro- 
tection of  the  brain  and  its  membranes,  and  important 
blood-vessels  and  nerves.  It  is  composed  of  twenty-two 
bones,  enumerated  in  the  following  manner : 

Cranium  (8  bones).— Occipital,  1;  parietal,  2;  frontal, 
1 ;  temporal,  2 ;  sphenoid,  1 ;  ethmoid,  1. 

Face  (14  bones).— Nasal,  2 ;  superior  maxillary,  2 ; 
lachrymal,  2;  malar,  2;  palate,  2;  inferior  turbinated,  2; 
vomer,  1  ;  inferior  maxillary,  1. 

The  cranial  bones  protect  the  brain,  and  are  uniformly 


BONE. 


Occipital. 


Fig.  4.— The  skull. 


strong  and  compact;  while  the  hones  of  the  face  contain 
principally  the  organs  of  special  sense,  and  give  the  proper 
symmetry  to  this  portion  of  the  skull,  some  of  them  are 
extremely  thin,  and  are  readily  broken.  The  different 
bones  of  the  skull  are  connected  by  sutures  or  "  seams," 
and  the  overriding  of  these  bones  lessens  the  size  of  the 
head  during  birth,  and  x^ermits  variations,  in  size,  for  some 
little  time  afterward. 

The  f ontanelles,  or  "  soft  spots  "  on  an  infant's  head,  cor- 
respond to  the  subsequent  points  of  union  of  two  or  more 
bones  of  the  cranium,  which  have  not  become  fully  hard- 
ened or  ossified,  but  still  retain  the  character  of  the  mem- 


10 


PROMPT    AID   TO    THE   INJURED. 


brane  or  soft  structure  from  whicli  the  cranial  bones  are 
originally  developed.  These  spots  disappear  when  the  bone 
becomes  f  ull^^  develox3ed  or  ossified,  which  generally  occurs 
within  one  and  a  half  or  two  years  after  birth. 

A  large  opening  exists  at  the  base  of  the  skull  in  the 
occipital  bone,  called  the  "  foramen  magnum,"  for  the  trans- 
mission of  the  spinal  cord  from  the  brain  to  the  canal  in 
the  spinal  column.  Other  and  smaller  openings  are  found 
in  the  skull  which  transmit  blood-vessels  and  nerves. 

The  skull  is  supported  by  the  vertebral  column.  The 
first  cervical  vertebra  is  firmly  attached  to  the  base  of 
ihe  skull  at  the  "  foramen   magnum,"  while  the  second 

cervical  acts  as  a  piv- 
ot, having  a  vertical 
or  upright  portion, 
called  the  "  odontoid  " 
process,  which  fits 
into  the  first  cervical 
vertebra,  and  around 
which  the  head  ro- 
tates. 

The  hyoid  bone  is 
an  arch,  something 
like  a  horseshoe, 
which  is  placed  above 
the  prominence  on 
the  front  of  the  neck 
called  the  pomum  Ad- 
ami,  or  "  Adam's  ap- 
ple," and  aids  in  sup- 
porting the  tongue, 
and  gives  attachment 
to  certain  muscles. 

The      thorax     or 

chest     (Figs.     5    and 

6)  is  the  bony  frame-work  which  contains  the  heart,  lungs, 

and  important  blood-vessels  and  nerves,      It  is  formed 


Fig.  5.— Thorax,  anterior  view  (Sappey). 
1,  2,  3.  Pternum  :  4.  circumference  of  the  upper 
portion  of  the  thorax  :  5.  circumference  of 
the  base  of  the  thorax  ;  6.  first  rib  ;  7,  sec- 
ond rib  ;  8,  last  two,  or  floating  ribs  ;  9, 
costal  cartilages. 


BONE. 


11 


by  the  sternum  in 
front,  and  the  ribs  and 
vertebrae  at  the  side 
and  back,  and  is  sepa- 
rated from  the  abdom- 
inal cavity  by  a  mus- 
cular partition  known 
as  the  diaphragm  or 
"midi-iff." 

The  sternwn  or 
'■  breast  -  bone  "  is  a 
fiat  and  narrow  bone 
about  seven  inches 
long,  situated  in  the 
front  of  the  chest,  and 
supporting  the  clavi- 
cles or ''  collar-bones  " 
and  the  ribs,  with  the 
exception  of  the  last 
two  ribs. 

The  ribs  (Fig.  7) 
are  twenty  -  four  in 
number,  twelve  on  each  side,  and  are  numbered  from 
above  downward.  They  articulate  posteriorly  with  the 
dorsal  vertebrae,  and  the  upper  ten  connect  in  front  with 
the  sternum  by  means  of  cartilages  (costal  cartilages), 
which  are  interposed  between  the  ends  of  the  ribs  and 
the  sternum,  and  allow  of  greater  motion  and  elastic- 
ity. The  two  lower  ribs,  the  eleventh  and  twelfth,  are 
simply  connected  with  the  vertebrae,  and  are  known  as 
"floating"  ribs,  as  they  have  no  attachment  in  front. 
The  peculiar  arrangement  and  attachment  of  the  ribs  ren- 
der them  a  very  important  element  in  respiration  ;  during 
this  act  the  ribs  are  elevated  and  depressed  bj^  the  action 
of  the  respiratory  muscles.  When  the  ribs  are  elevated 
during  inspiration,  the  thorax  or  chest  is  enlarged  and  air 
passes  into    the  lungs  ;    in   expiration  the  ribs  are  de- 


FiG.  6.— Thorax,  posterior  view  (Sappey). 
1,  1,  spinous  processes  of  the  dorsal  vertebrae  ; 
2,  2,  laraiiiifi  of  the  vertebrae  ;    3,  3,  trans- 
verse processes  ;  4,  4,  dorsal  portions  of  the 
ribs  ;  5,  5,  angles  of  the  ribs. 


12 


PROMPT  AID   TO   THE   INJURED, 


pressed,  the  cavity  diminislied  in 
size,  and  the  aii'  in  the  lungs  is  ex- 
pelled. The  elasticity  of  these  bones 
is  illustrated  by  the  fact  that  chil- 
dren in  Arabia  use  the  ribs  of  cam- 
els for  bows. 

Upper  extremities. — Each  upper 
extremity  is  composed  of  thirty-two 
bones,  and  includes  the  following  : 
scapula,  clavicle,  humerus,  radius, 
ulna,  eight  carpal  bones,  five  meta- 
carpal bones,  and  fourteen  phalanges. 

The scapifZce, or  "shoulder-blades" 
(Fig.  8),  are  thin,  flat,  and  triangular 
bones,  which  have  on  their  posterior 
and  upper  part  an  elevation  or  ridge 
knowTi  as  the  "  spine  "  ;  the  external 
extremity  of  the  spine  is  the  acro- 
mion process,  which  connects  with 
the  outer  end  of  the  clavicle.  The 
outer  and  upper  portion  of  the  scap- 
ula forms  the  glenoid  cavity  or 
"socket"  which  receives  the  ball- 
shaped  head  of  the  humerus  or  "  arm- 
bone."  The  scapula,  in  this  manner, 
assists  in  the  formation  of  the  shoul- 
der-joint. It  also  furnishes  broad  sur- 
faces for  the  attachment  of  muscles, 
and  aids  in  protecting  the  contents 
of  the  thorax. 

The  clavicles  or  "collar-bones" 
(Fig.  9),  shaped  something  like  the 
italic  letter  /,  are  on  the  anterior  and 
upper  part  of  the  chest,  and  extend 
from  the  upper  }3ortion  of  the  ster- 
num or  "breast-bone"  to  the  acro- 
mion   processes    of    the     shoulder- 


BONE.  13 

blades  referred  to  above  ;  they  hold  the  shoulders  upward, 
backward,  and  outward.     When  a  clavicle  is  broken  the 


Fig.  8.— Left  scapula,  or  shoulder-blade. 


arm  drops  downward,  forward,  and  inward,  its  support  be- 
ing gone.  Manual  labor  increases  the  size,  strength,  and 
curvature  of  the  clavicle.  The  collar-bone  is  less  curved 
in  women  than  in  men. 


l_j.  PROMPT   AID   TO   THE   IXJURED. 

The  humerus  or  "arm-bone  ''  (Fig.  10)  is  the  longest  and 
strongest  bone  of  the  upper  extremity.  It  has  a  shaft  and 
two  extremities  :  the  upper  extremity  is  the  largest  part  of 


Fig.  9. — Anterior  surface  of  left  clavicle,  or  collar-bone. 

the  bone,  and  consists  of  a  head  joined  to  the  shaft  by  a 
very  short  and  constricted  x^ortion  called  the  "anatomi- 
cal"  neck.  The  head  is  globular  in  form,  covered  with 
cartilage,  and  articulates  with  the  glenoid  cavity  of  the 
scapula,  already  spoken  of,  forming  with  it  a  ball-and- 
socket  joint.  The  cartilage  covering  the  head  protects  it 
and  prevents  undue  friction  in  the  joint.  At  the  point 
where  the  anatomical  neck  joins  the  shaft  are  found  two 
rough  eminences  called  tuberosities,  which  are  for  muscu- 
lar attachment.  Just  below  the  tuberosities  is  another 
constriction — the  "  surgical  "  neck — so  called  from  the  fact 
that  it  is  the  most  common  site  of  fracture  of  the  upper 
extremity.  The  shaft  is  partly  cylindrical,  prismatic,  and 
flattened,  and  roughened  for  the  attachment  of  muscles. 
The  lower  extremity  is  a  broad  and  flattened  (from  before 
backward)  portion  of  the  bone  which  articulates  with 
the  ulna  principally,  and  to  a  certain  degree,  with  the 
radius  of  the  forearm,  these  three  bones  forming  the 
elbow-joint.  The  humerus  has  a  greater  range  of  mo- 
tion than  any  other  bone  in  the  body,  and  is  oftener  dis- 
located. 

The  radius  and  ulna  (Fig.  11)  are  the  bones  that  con- 
stitute the  forearm. 

The  radius,  so  called  from  its  fancied  resemblance  to 


BONE, 


the  spoke  of  a  wheel,  is  the 
external  bone  lying  parallel 
with  the  ulna  when  the  palm 
of  the  hand  is  turned  up- 
ward. It  resembles  other 
long-  bones  in  having  a  shaft 
and  two  extremities.  The  up- 
per or  lesser  extremity  forms 
only  a  small  portion  of  the  el- 
bow-joint, while  the  lower  ex- 
tremity, w^hich  is  broad,  forms 
the  wrist-joint  by  articulat- 
ing with  two  of  the  carpal  or 
wrist  bones.  The  low^er  end 
also  articulates  with  the  cor- 
responding portion  of  the  ul- 
na. The  shaft  of  the  radius  is 
more  or  less  irregular  and 
rough  for  the  origin  and  in- 
sertion of  muscles.  The  ease 
with  which  the  forearm  and 
hand  may  be  turned  with  the 
palm  down  ("  pronation  "), 
and  with  the  palm  up  ("su- 
pination "),  is  due  to  the  pe- 
culiar articulation  of  the  up- 
per end  of  the  radius  with  the 
ulna.  The  upper  end  of  the 
radius  (or  head)  is  somewhat 
knob-shaped,with  a  depression 
or  excavation  on  its  ux^per 
surface ;  the  excavation  artic- 
ulates with  a  small  portion  of 
the  lower  extremity  of  the 
humerus,  and  represents  the 
limited  part  it  takes  in  the 
formation  of  the  elbow-joint. 


f.V: 


-^^' 


A^y 


o— i 


Trochlea.     Radial  Head. 
Fig.  10. — T.ef  t  humerus,  or  arm-boue 


PROMPT   AID   TO   THE   INJURED. 


Artie,  with  Semi-lunar 
and  Scaphoid  of  Carpus. 
Fig.  11. — Left  radius  and  ulna,  or  bones 
of  the  fore-arm. 


Below  tlie  portion  of  the 
radius  just  described  is  a 
constricted  portion,  called 
tlie  neck  ;  a  ligament  in 
the  form  of  a  loop,  named 
the  orbicular  ligament,  is 
thrown  around  this  part, 
and  attached  to  the  outer 
side  of  the  ulna  ;  this 
ligament,  while  it  holds 
the  radius  in  position,  al- 
lows the  neck  of  the  ra- 
dius, which  it  encu'cles, 
to  freely  rotate. 

The  ulna,  which  is 
composed  of  a  shaft  and 
two  extremities,  is  the 
companion  of  the  radius, 
and  situated  internal  to 
it ;  the  lower  extremity  is 
very  small,  and,  although 
connected  with  the  radi- 
us, has  no  articulation 
with  tlie  carpal  or  wrist 
bones,  consequently  it 
does  not  enter  into  the 
formation  of  the  wrist- 
joint  ;  but  the  upper  end 
is  large,  and  contains  a 
depression  or  cavity 
which  receives  the  lower 
extremity  of  the  humer- 
us. The  prominent  point 
of  the  elbow  is  the  ex- 
treme end  of  the  ulna, 
and  is  known  as  the 
"olecranon    process"  of 


BOXE. 
Articulate  with  Radius  forming  Wrist-Joint. 


17 


Ctrpua. 


Metacarpus 


Phalanges 


Fig.  12.— Bones  of  the  left  hniid.     Palmar  surface. 


18  PROMPT   AID   TO   THE   IXJUREB. 

the  ulna  or  "  funny-bone,"  so  called  from  tlie  peculiar  sen- 
sation experienced  wlien  the  ulnar  nerve,  which  is  closely 
associated  with  the  inner  border  of  this  process,  is  struck. 
The  upper  extremity  of  the  ulna  and  the  lower  extremity 
of  the  humerus  make  up  the  elbow-joint — that  is,  the  prin- 
cipal part  of  it  ;  while,  as  already  described,  the  upper  end 
of  the  radius  articulates  with  a  small  and  less  important 
part  of  the  lower  extremity  of  the  humerus. 

The  carpus  or  wrist  (Fig.  12)  consists  of  the  following 
small  and  irregular  bones,  arranged  in  two  rows :  the  up- 
per, composed  of  the  scaphoid,  semi-lunar,  cuneiform,  and 
pisiform,  and  the  lower  row,  of  the  trapezium,  trapezoid, 
OS  magnum,  and  unciform.  The  large  number  of  bones 
constituting  the  carpus,  and  having  so  many  small  joints, 
increases  its  strength,  motion,  and  elasticity.  They  also 
diminish  shock  and  the  tendency  to  fracture,  which  would 
be  frequent  if  the  wrist  were  composed  of  one  bone.  The 
carpus  supports  the  hand  and  preserves  its  symmetry. 

The  metacarpus  (Fig.  12)  consists  of  five  long  bones 
(metacarpal),  connecting  the  carpus  with  the  bones  of  the 
fingers  and  thumb ;  they  form  the  bony  framework  of  the 
palm  and  back  of  the  hand. 

The  phalanges  (Fig.  12)  are  miniature  long  bones,  hav- 
ing a  shaft  and  two  extremities,  and  are  foui'teen  in  num- 
ber, three  for  each  of  the  fijigers  and  two  for  each  thumb ; 
their  position  can  be  easily  demonstrated  by  bending  the 
fingers.  The  bases  of  the  fii^t  row  of  phalanges  articulate 
with  the  heads  of  the  metacarpal  bones  ;  the  remaining 
phalanges  articulate  with  each  other.  "When  the  hand  is 
open,  the  fijigers  do  not  correspond  in  length ;  but  when 
closed,  in  grasping  an  object,  there  is  no  apparent  differ- 
ence. If  the  fijigers  when  closed  were  uneven,  the  grasp- 
ing power  would  be  diminished.  The  thi'ee  rows  of  pha- 
langes grow  progressively  smaller  toward  the  end  of  the 
fingers. 

The  pelvis  or  "  basin  "  supports  the  trunk  and  protects 
the  pelvic,  and  a  portion  of  the  abdominal  organs.     It  is 


BONE 


composed  of  the  two  innom- 
inate or  "haunch"  bones,  the 
sacrum,  and  the  coccyx  ;  the 
last  two  have  been  described 
with  the  spinal  column. 

The  innominate  bones 
(Fig.  2)  are  situated  one  on 
each  side  and  in  front,  and 
form  the  greater  portion  of 
the  pelvis,  while  the  sacrum 
and  coccyx  form  the  posterior 
portion.  On  the  outer  side  of 
an  innominate  bone  is  found 
a  depression  or  socket,  known 
as  the  cotyloid  cavity  or  ace- 
tabulum, corresponding  in 
function  to  the  glenoid  cav- 
ity of  the  scapula,  which  re- 
ceives the  head  of  the  femur 
or  "thigh-bone." 

The  femur  (Fig.  13)  is  the 
longest  and  strongest  bone 
in  the  body  ;  its  length  is 
characteristic  of  the  human 
skeleton.  In  the  erect  posi- 
tion, the  tips  of  the  fingers 
reach  to  about  the  middle  of 
the  thigh,  while  in  the  orang- 
outang, the  fingers  reach  to 
the  ankle.  This  depends  also 
on  the  comparative  short- 
ness of  the  arm  in  the  human 
skeleton. 

The  femur  is  divided  into 
a  shaft  and  two  extremities, 
the  upper  extremity  being 
composed  of  a  globular  head, 


Outer  Condyle.  Inner  Condyle. 

Fig.  13.— Right  femur,  or  thigh-bone. 


20 


PROMPI   AID   TO   THE   IXJURED. 


whicli  is  connected  ob- 
liquely with  the  shaft  by 
quite  a  long  neck ;  at  the 
j)oint  where  the  neck 
joins  the  shaft  there  are 
two  prominences,  the 
higher  being  the  larger, 
and  on  the  outer  side 
of  the  bone,  and  called 
the  gTcat  trochanter,  the 
smaller  one  being  on  the 
inner  side,  and  somewhat 
below,  known  as  the 
lesser  trochanter.  The 
eminences  are  for  the  in- 
sertion of  muscles.  The 
head  of  the  femur  is  con- 
tained in  the  cotyloid  cav- 
ity or  acetabulum  of  the 
innominate  or  haunch 
bone.  The  long  neck  of 
the  femur  keejjs  the  shaft 
at  the  jjroi^er  distance 
from  the  pelvis,  prevents 
any  interference  with  its 
action,  and  allows  greater 
motion.  The  shaft  of  the 
femur  is  almost  cylindri- 
cal, and  furnishes  sur- 
faces which  are  some- 
what roughened  for  the 
origin  and  insertion  of 
muscles.  The  lower  ex- 
tremity is  very  large  and 
broad,  articulates  with 
the  upper  extremity  of 
the  tibia  or  leg-bone  and 


Fig.  14. — 'Right  ifbia  or  shm-ljoiie,  and 

Sbula  or  !?p]mt-boi)e.    Anterior  surface. 


BONE. 


21 


the  patella  or  knee- 
cap, and  forms  the 
knee-joint. 

The  femur  ar- 
ticulates \vith  the 
pelvis,  tibia,  and  pa- 
tella. 

The  tibia,  or  ''shin- 
bone  "  and  Jib  u  J  a  or 
"  splint  -  bone  "  (Fig. 
l^t)  are  the  bones  of 
the  leg.  and  have 
the  characteristics  of 
long  bones. 

The  tibia,  wliich 
is  very  superficial  in 
front  (having  only 
the  skin  as  a  cover- 
ing), is  the  lai'ger  of 
the  two  bones,  and  is 
consti'ucted  mainly 
for  strength,  and  sup- 
jDorts  the  f  emiu' :  it 
also  furnishes  attach- 
ment for  a  few  mus- 
cles. The  dii'ection 
of  the  tibia  is  verti- 
cal. 

The  fibula  is  the 
companion  -  bone  of 
the  tibia  and  is  ex- 
ternal to  it.  It  is 
about  the  length  of 
the  tibia,  and  is  very 
sKm.  and  helps  to 
support  the  tibia  and 
form  the  ankle-joint. 


Fig.  15. 


Dorsal  surf  ace. 


22 


PROMPT   AID   TO   THE   INJURED. 


and  also  furnishes  the  origin  of  a  number  of  important 
muscles. 

The  patella  or  "knee-cap  "  (Fig.  16)  is  situated  in  front 
of  the  knee-joint ;  it  is  in  the  tendon  of  a  muscle,  and  as- 
sists in  protecting  the  joint,  and 
also  aids  in  properly  extending 
the  leg.  When  the  leg  is  ex- 
tended and  the  muscles  are  re- 
laxed, it  will  be  found  that  the 
patella  is  freely  movable. 

The  tarsus  or  "instep"  (Fig. 
15)  corresponds  to  the  carpus  in 
the  upper  extremity,  and  consists 
of  seven  bones  (tarsal),  viz. :  cal- 
caneum  or  os  calsis,  astragalus, 
cuboid,  navicular,  internal  cunei- 
form, middle  cuneiform,  and  external  cuneiform. 

The  metatarsal  (Fig.  15)  bones  correspond  to  the  meta- 
carpal bones  in  number  (Fig.  12),  and  in  a  general  way  to 
their  description. 

The  phalanges  (Fig.  15)  are  fourteen  in  number,  and 
arranged  in  the  same  manner  as  the  phalanges  of  the 
hand. 


Fig.  16. — The  patella,  or  knee 
cap. 


CHAPTER  II. 

JOINTS—  CARTILA  G E— LIGAMENTS— S  YNO  VIAL  MEM- 
BRANE—MUSCLES. 

JOINTS. 

Bones  are  joined  at  different  points,  constituting  articu- 
lations or  "  joints  "  ;  some  are  immovable,  as  joints  of  the 
skull ;  others  slightly  movable,  as  joints  of  the  spine ; 
while  the  remainder  are  freely  movable,  as  the  knee  and 
shoulder  joints,  joints  of  the  fingers,  etc. 

The  movable  joints  are  divided  into  four  kinds : 

1.  Joints  having  a  gliding  movement ;  as  the  tarsus 
and  carpus. 

2.  Ball-and-socket  joints,  as  where  a  globular  head  is 
received  into  a  cup-like  cavity,  and  admitting  of  motion  in 
all  directions,  as  shoulder  and  hip. 

3.  Hinge-joints,  where  the  motion  is  limited  to  two 
directions ;  forward  and  backward,  as  the  elbow. 

4.  Pivot  joints,  where  rotation  only  is  permitted,  as  the 
joint  between  the  atlas  and  axis  and  the  joint  between  the 
radius  and  ulna. 

Other  varieties  of  joints  sometimes  described  are  sim- 
ply modifications  of  the  above. 

Joints  admit  of  the  following  movements  :  flexion,  ex- 
tension, rotation,  adduction,  abduction,  circumduction. 

Flexion  takes  place  when  the  forearm  is  bent  upon 
tlie  arm,  the  leg  upon  the  thigh,  etc. ;  and  extension,  when 
these  parts  are  extended  or  straightened  ;  rotation  occurs 
when  a  part  is  turned  in  and  out ;  adduction  is  illustrated 
by  the  movement  which  carries  the  arm  or  leg  toward  the 
one  of  the  opposite  side  or  toward  the  median  line  of  the 
body ;  abduction,  the  movement  in  the  opposite  direction  ; 


24:  PROMPT  AID   TO  THE   INJURED. 

circumduction  is  exemplified  when  the  arm  is  swung 
in  a  circle,  as  at  the  shoulder- joint. 

The  following  structures  enter  into  the  formation  of  a 
joint,  viz.  :  bone,  cartilage,  ligaments,  tendons,  synovial 
membrane,  blood-vessels,  and  nerves. 

CARTILAGE. 

Cartilage  or  "gristle"  is  a  very  firm  and  dense  sub- 
stance, found  principally  in  joints,  and  covers  the  ends  of 
bones  entering  into  their  formation  ;  it  protects  the  adja- 
cent bony  surfaces  against  friction,  and  also  prevents 
shock  which  would  occur  if  the  bones  were  directly  ap- 
plied to  each  other.  The  continued  pressure  brought  to 
bear  on  cartilage  would  render  it  subject  to  pain,  inflam- 
mation, and  disease  if  it  were  supplied  with  nerves  and 
blood-vessels ;  consequently,  cartilage  has  no  nerve-  or 
blood-supply,  and  is  known  as  the  non- vascular  tissue; 
it  absorbs  its  nutrition  from  the  surrounding  tissue  by  a 
process  known  as  "  imbibition."  Cartilage  connected  with 
ribs  has  already  been  described  (see  Ribs).  Cartilage  is 
also  found  in  tubes  such  as  the  air-passages,  ears,  nose,  etc., 
where  it  is  necessary  that  these  channels  should  be  kept 
permanently  open. 

LIGAMENTS. 

Ligaments  are  of  two  kinds,  viz.,  the  white  fibrous  and 
the  yellow  elastic. 

The  white  fibrous  ligaments  are  composed  of  bundles 
of  white  fibrous  tissue  which  are  closely  interlaced  ;  they 
are  found  at  the  movable  joints,  and  serve  to  connect  the 
extremities  of  the  bones  forming  an  articulation ;  they  are 
inextensible  but  very  flexible  and  strong,  and,  while  they 
admit  of  the  free  movement  necessary  at  the  joint,  they  do 
not  allow  the  articular  ends  of  the  bones  to  be  abnormally 
displaced.  When  a  dislocation  occurs,  the  ligaments  are 
either  ruptured  or  torn  from  their  attachments.  The  liga- 
ments composed  of  yellow  elastic  tissue  are  extremely  ex- 
tensible, and  are  fewer  in  number  than  those  composed  of 


JOINTS,    LIGAMENTS,    MUSCLES,   ETC.  25 

white  fibrous  tissue.  Examples  of  this  variety  are  the 
ligaraenta  subflava  and  the  ligamentum  nuchae.  The 
latter  extends  from  the  spinous  process  of  the  seventh 
cervical  vertebra  to  a  protuberance  on  the  occipital  bone 
at  the  base  of  the  skull.  It  is  rudimentary  in  man,  but 
well  developed  in  animals,  where  it  aids  in  suj)porting  the 
head,  and  acts  as  a  substitute  for  muscular  power.  The 
"  ligamenta  subflava "  are  small  ligaments  of  the  same 
tissue  (yellow  elastic)  connected  with  the  different  verte- 
brae composing  the  spinal  column ;  their  action  is  similar 
to  that  of  the  ligamentum  nuchas,  and  assist  in  bringing 
the  vertebral  column  to  an  erect  position. 

SYNOVIAL   MEMBRANE. 

The  synovial  membrane  is  a  delicate  structure  con- 
nected with  movable  joints  and  covering  the  inner  side  of 
the  ligaments.  It  is  not  found  between  the  articular  sur- 
faces of  the  bones  composing  the  joints.  The  synovial 
membrane  secretes  a  thickish,  glairy  fluid,  resembling  in 
appearance  the  white  of  an  egg,  and  it  is  known  as  sy- 
novia or  "joint  oil,"  which,  passing  into  the  joints,  lubri- 
cates the  cartilages  and  prevents  friction.  The  synovial 
membrane  may  become  inflamed  as  the  result  of  injury  or 
disease,  producing  stiffness  of  the  joint,  or  anchylosis. 

MUSCLES. 

Muscles  are  bundles  of  reddish-brown  fibers  having  the 
power  of  contraction,  and  are  divided  into  two  kinds,  viz., 
voluntary  or  striped,  and  involuntary  or  unstriped ;  the 
terms  striped  and  unstriped  refer  to  the  microscopical  ap- 
pearance of  the  fibers  composing  the  muscle. 

The  voluntary  muscles  are  under  the  control  of  the 
will,  and  comprise  the  bulk  of  the  muscular  system ;  they 
are  attached  to  the  different  parts  of  the  skeleton,  and  act 
on  the  bones  as  levers ;  they  are  the  agents  of  locomotion 
and  of  the  movements  of  all  portions  of  the  body;  they 
also  protect  the  different  structures  beneath  them,  and  give 


26 


PROMPT   AID   TO    THE    INJURED. 


Fig.  it.— The  muscular  system. 


JOINTS,   LIGAMENTS,   MUSCLES,   ETC.  27 

grace  and  symmetry  to  the  form  (Fig.  17).  When  mus- 
cles become  diminished  in  size  or  illy  developed,  the  per- 
son is  angular  or  bony. 

The  lean  meat  used  for  food  is  muscular  tissue. 

Muscles  are  of  different  lengths  and  shapes — long,  short, 
broad,  etc.  The}^  are  arranged  in  pairs — that  is,  there  are 
corresponding  muscles  on  each  side  of  the  body,  although 
some  exist  singl}^  There  are  over  four  hundred  nmscles 
in  the  human  frame.  In  many  situations  the  outlines  of 
muscles  are  apparent  to  the  eye,  and  are  utilized  as  guides 
to  the  location  of  important  blood-vessels  and  nerves. 

Muscles  are  surrounded  by  a  thin,  web-like  tissue  known 
as  fascia,  which  serves  as  a  support  for  them  and  allows  of 
their  movements  without  undue  friction. 

Muscles  are  composed  of  a  belly  and  two  extremities. 
The  more  fixed  extremity  is  called  the  origin,  and  the 
movable  one  the  insertion  ;  however,  in  some  muscles  the 
origin  and  insertion  are  equally  movable.  During  con- 
ti^action  their  origins  and  insertions  approximate,  and  mus- 
cles shorten  and  thicken ;  this  can  be  illustrated  by  raising 
a  heavy  weight  with  the  hand,  when  the  biceps  muscle  in 
the  arm  will  be  seen  to  thicken  and  bulge  forward.  Mus- 
cles gradually  diminish  in  size  toward  their  extremities, 
the  muscular  tissue  being  replaced  by  an  extremely  firm 
and  resisting  substance  called  white  fibrous  tissue,  consti- 
tuting a  tendon. 

The  tendons  are  directly  and  intimately  connected  with 
the  periosteum  covering  the  bone,  and  sometimes  directly 
with  the  bone.  They  differ  from  muscular  tissue  in  ap- 
pearance— being  white  and  glistening. 

An  aponeurosis  is  simply  an  expanded  tendon,  and  is 
found  where  the  muscle  has  a  broad  attachment. 

Muscles  are  abundantly  supplied  with  blood-vessels, 
nerves,  and  lymphatics,  but  tendons  have  few  blood-vessels 
and  only  those  of  the  largest  size  have  nerves. 

The  nerves  connected  with  the  muscles  transmit  to 
them  a  stimulus  from  the  brain  and  spinal  cord,  which 


28  PROMPT   AID   TO    THE   INJURED. 

calls  their  function  into  action.  In  the  disease  known 
as  tetanus,  or  "  locked- jaw,"  the  stimulus  is  sometimes  so 
great,  and  the  contraction  so  intense,  that  the  muscular 
fibers  are  ruptured. 

The  stiffness  that  ensues  after  death  (rigor  mortis)  is 
due  to  a  solidification  of  some  of  the  fluid  portions  of  the 
muscle,  which  is  succeeded  after  a  short  time,  however,  by 
relaxation  of  the  body.  It  is  said  that  this  rigidity  is  not 
present,  or  only  very  transient,  in  one  killed  by  lightning. 

If  a  muscle  is  not  suflBciently  used  it  becomes  dimin- 
ished in  size  (atrophy),  and  from  continued  non-use  may 
undergo  degeneration,  from  which  there  is  no  recovery  ; 
consequently  a  muscle  should  not  be  confined  or  unused 
too  long.  Hypertrophy  represents  the  opposite  condition 
to  atrophy,  the  muscles  being  increased  in  size,  and  may 
be  the  result  of  constant  exercise  ;  it  is  often  noticeable  in 
athletes.  The  contraction  of  a  voluntary  muscle  is  very 
rapid  and  abrupt. 

The  involuntary  or  unsti'iped  muscles  are  not  con- 
nected with  bones,  but  form  the  muscular  ]>ortion  of  the 
stomach,  intestines,  and  other  mternal  organs,  and  also 
the  muscular  coat  of  the  blood-vessels.  The  contraction 
of  this  form  of  muscular  fiber  is  slow,  unequal,  and  does 
not  affect  all  portions  of  tne  muscle  simultaneously.  The 
involuntary  muscles  are  not,  as  a  rule,  under  the  control 
of  the  will ;  they  have  no  tendons ;  the  muscular  fibers 
simply  interlace  with  each  other.  Although  the  muscular 
fibers  of  the  heart  are  striped,  like  voluntary  muscular 
fibers,  this  organ  is  an  involuntary  muscle,  and  not  under 
the  control  of  the  will,  this  being  the  only  exception  to 
the  rule. 

Reference  will  frequently  be  made  in  the  following 
chapters  to  organs,  glands,  mucous  and  serous  membranes, 
and  also  to  secretion  and  excretion,  so  then  for  the  sake  of 
convenience  these  terms  will  now  be  explained. 

An  organ  is  a  part  of  the  animal  organism  having  a 


JOINTS,   LIGAMENTS,   MUSCLES,   ETC,  29 

special 'function  to  perform,  as  the  brain,  heart,  stomach, 
kidneys,  etc. 

A  gland  is  an  organ,  but  it  also  has  the  additional 
function  of  abstracting  from  the  blood,  material  which  it 
discharges  from  the  body  unchanged  (excretion),  as  urine, 
or,  it  manufactures  from  certain  parts  of  the  blood,  a  fluid 
(secretion)  which  has  a  particular  function,  as  the  gastric 
juice. 

Mucous  and  serous  membranes  line  the  interior  of  cavi- 
ties, sacs,  tubes,  etc.  Serous  membranes,  except  the  peri- 
tonaeum in  the  female,  hue  cavities  and  tubes  which  are 
closed  and  have  no  communication  with  the  outer  world 
(examples :  pericardium  pleura,  and  peritonaeum) ;  while 
mucous  membranes  line  structures  which  open  exter- 
nally (examples :  respiratory  and  alimentary  tracts). 
Both  membranes  secrete  a  small  amount  of  fluid,  which 
keeps  their  surface  moist  and  pliable,  and  prevents  fric- 
tion ;  in  addition  to  this,  some  mucous  membranes  have 
small  glands  in  their  structure  which  produce  a  secretion 
having  a  distinctive  function,  as  the  mucous  membrane 
lining  the  stomach,  which  secretes  the  gastric  juice. 

A  secretion  is  a  fluid  formed  in  and  by  a  gland  or 
organ  for  a  special  purpose.  It  is  peculiar  to  the  organ 
that  produces  it  and  is  found  in  no  other  part,  and  conse- 
quently never  exists  in  the  blood ;  examples  :  gastric  juice, 
bile,  etc. 

An  excretion  represents  certain  material  which  is 
always  present  in  the  blood,  composed  principally  of 
waste  matter ;  it  is  not  formed  in  the  excretory  organ,  but 
is  simply  removed  'from  the  blood  and  discharged  from 
the  body.  The  urine  is  an  example  of  an  excretion,  the 
kidneys  being  excretory  organs. 

Some  organs  have  both  excreting  and  secreting  func- 
tions ;  the  liver  is  an  example  of  this  type. 


CHAPTER  III. 

TEE  BLOOD   AXB    CIRGVLATORY  ORGANS. 

Blood  is  the  great  nutritive  fluid,  of  the  body.  It  dis- 
tributes to  the  different  tissues  material  necessary  for  their 
proper  maintenance  and  activity.  It  supplies  heat  and  also 
oxygen,  receiving  the  latter  from  the  air.  It  is  absolutely 
necessary  that  the  tissues  should  be  constantly  furnished 
with  oxygen,  otherwise  death  would  ensue  from  suffoca- 
tion, as  in  drowning.  The  blood  has  also  the  important 
function  of  removing  from  the  body  through  certain  or- 
gans, principally  the  kidneys,  lung-s  and  skin,  worn-out 
and  waste  matter,  which,  if  retained  in  the  body,  would 
produce  serious  disease  or  death. 

Blood  is  composed  of  a  liquid  and  a  solid  portion.  The 
liquid  portion  or  "  plasma,"  which  constitutes  about  two 
thirds  of  the  blood,  is  almost  colorless  when  separated  from 
the  solid  matter  or  "corpuscles,"  and  contains  the  principal 
elements  of  nutrition,  which  it  distributes  to  the  different 
tissues  in  its  course  throughout  the  system,  receiving  in 
return  waste  material  which  is  to  be  discharged  from  the 
body. 

The  corpuscles  or  solid  portion  float  in  the  plasma.  They 
are  divided  into  three  kinds,  viz.,  red  corpuscles,  leuco- 
cytes or  white  corpuscles,  and  those  known  as  blood 
plaques.  The  red  corpuscles  are  by  far  the  most  impor- 
tant and  numerous  ;  they  resemble  in  appearance  a  thick 
coin  which  has  been  made  thin  in  the  center  on  both 
sides,  or  biconcave.  These  little  bodies  are  exceedingly 
small ;  thirty-five  hundred  of  them  laid  side  by  side  on 
their  flat  surface  would  be  required  to  cover  the  space  of 
one  inch.  They  are,  of  course,  not  visible  to  the  naked 
eye.  When  examined  by  the  microscope  they  appear 
straw-colored ;  but  when  vast  numbers  are  crowded  to- 
gether, as  in  the  normal  condition  of  the  blood,  they  give 


THE   BLOOD  AND   CIRCULATOUY   ORGANS. 


31 


to  it  the  cliaracteristic  red  color.  Physiologists  have  cal- 
culated that  there  are  over  fifty  billions  of  them  in  the 
human  body.  The  red  corpuscles  are  the  agents  that  re- 
ceive oxygen  from  the  air  in  the  lungs  and  distribute  it  to 
the  tissues  throughout  the  body.  The  white  corpuscles  are 
larger  than  the  red  (about  ^^V^  of  an  inch  in  diameter), 
and  are  globular  in  form.  The  blood  plaques  are  exceed- 
ingly small,  only  about  ^ji^  to  -roio^  of  an  inch  in  diam- 
eter ;  both  the 
plaques  and  the 
vv^hite  corpuscles 
are  much  fewer 
than  the  red 
corpuscles,  and 
their  normal 
function  is  not 
defin  itely  known 
(Fig.  18). 

The  amount 
of  blood  in  the 
human  body 
represents  about 
one  twelfth  to 
one  thirteenth  of 
its  weight.  It  is 
an  alkaline  fluid, 
and  somewhat 
heavier  than  water.  Arterial  blood,  or  that  which  has 
been  purified  in  the  lungs,  is  of  a  bright  red  color,  while 
the  venous  blood  is  purplish. 

Some  tissues,  such  as  the  hair,  cartilage,  nails,  etc.,  are 
not  supplied  with  blood,  but  receive  their  nutrition  by  ab- 
sorption (imbibition)  from  surrounding  parts. 

Coagulation,  which  occurs  when  a  blood-vessel  is  opened, 
is  an  effort  of  Nature  to  arrest  haemorrhage.  It  also  takes 
place  in  the  blood-vessels  in  certain  abnormal  conditions 
of  the  blood.     Blood  circulates  throughout  the  body  by 


Fig.  18.— Human  red-blood  corpuscles,  and  two  white 
corpuscles. 


32 


PROMPT  AID  TO  THE  INJURED. 


means  of  blood-vessels,  which  are  divided  into  arteries, 
veins,  and  capillaries.  The  motive  power  or  force  that 
propels  the  blood  through  these  vessels  is  furnished  by- 
contractions  of  the  heart. 

THE  HEART. 
The  hearty  which  is  likened  to  a  pump,  is  a  hollow, 
muscular  organ,  conical  or  pear-shaped,  about  the  size 

of  a  closed  fist, 
four  or  five  inches 
long,  three  inches 
through,  and  weighs 
about  eight  to 
twelve  ounces  (Fig. 
19).  It  occupies  a 
position  in  the  tho- 
rax or  chest,  just  be- 
hind the  sternum  or 
"  breast-bone,"  and 
between  the  lungs, 
but  mainly  on  the 
left  side.  The  large 
end  or  "  base  "  of  the 
heart  is  directed  up- 
ward and  toward 
the  right  side,  while 
the  smaller  end  or 
"  apex  "  is  down- 
ward and  to  the  left. 
A  line  drawn  across 
the  sternum  at  the 
upper  border  of  the 
cartilage  forming 
the  extremity  of  the 
third  rib  would  in- 
dicate the  base  of  the  heart.  The  ajDex  is  found  in  the 
space  between  the  fifth  and  sixth  ribs,  three  and  a  half 


Fig.  19. — The  heart  and  large  blood-vessels.  A , 
right  ventricle  ;  .  B,  left  ventricle  ;  C,  right 
aui'icle ;  D,  left  auricle ;  B,  aorta ;  F,  pul- 
monary artery. 


THE   BLOOD   AND   CIKCULATOKY    ORGANS. 


inches  to  the  left  of  the  middle  line.    At  this  point  the 
pulsation' of  the  heart  may  be  distinctly  felt  (Fig.  20). 


i  •:  \  — -... 


f  \ 


A  ■■•-. 


//' 


\:\:JJ 


:  V-J 


"V^. 


Fig.  20.— Heart  and  ribs,    a,  5,  c,  d,  e,  ribs ;  1,  2,  3,  4,  5,  intercostal  spaces ; 
X,  position  of  nipple  (fourth  rib). 

The  heart  contains  four  cavities  or  chambers — two  au- 
ricles and  two  ventricles  ;  the  auricles  are  above  and 
the  ventricles  are  below,  or,  the  heart  may  be  divided 
into  a  right  and  left  side,  each  having  an  auricle  and  a 
ventricle.  The  ventricles  do  not  connect  with  each  other, 
nor  do  the  auricles,  but  an  auricle  connects  with  the  ven- 
tricle of  the  corresponding  side.  The  openings  between 
these  cavities  are  guarded  by  the  auriculo-ventricular 
valves,  and  they  are  so  arranged  that  the  blood  may  pass 
from  the  auricles  to  the  ventricles  ;  but  it  can  not  in  the 
normal  condition  return.  If  this  were  possible,  the  circu- 
lation of  blood  would  be  constantly  interfered  with.  The 
4 


34  PROMPT   AID   TO   THE   IXJURED. 

ventricles  are  larger  than  the  auricles  and  their  walls  are 
stronger,  particularly  the  walls  of  the  left  ventricle,  which 
drives  the  blood  received  from  the  lungs  throughout  the  en- 
tire system.  The  auricles  contract  simultaneously ;  the  con- 
traction of  the  ventricles  follows  immediately  afterward. 
Between  the  end  of  the  contraction  of  the  ventricles  and. 
the  beginning  of  the  contraction  of  the  auricles  is  a  pause 
which  it  is  estimated  gives  the  hearthalf  rest  and  half  work. 
This  double  action  represents  a  pulsation  of  the  heart,  of 
which  there  are  from  sixty  to  eighty  during  the  minute. 

The  heart  and  also  the  beginning  of  the  great  vessels  at 
the  base  of  the  heart  are  surrounded  by  a  closed  sac  (the 
pericardium)  composed  of  fibrous  tissue  and  lined  with  a 
serous  membrane.  The  inner  wall  or  visceral  layer  of  this 
serous  structure  is  adherent  to  the  heart ;  between  it  and 
the  outer  or  parietal  layer  exists  more  or  less  of  a  space, 
being  better  marked  at  the  lower  portion.  The  serous 
membrane  lining  the  space  secretes  a  fluid,  of  which  there 
is  usually  about  one  or  two  teaspoonf  uls  present,  thus  keep- 
ing the  membrane  soft  and  moist,  and  limiting  friction 
when  the  two  surfaces  rub  against  each  other  during  the 
action  of  the  heart.  The  broadest  portion  or  base  of  the 
pericardium,  which  is  the  outer  layer,  corresponds  in  situ- 
ation to  the  apex  of  the  heart.  This  arrangement  prevents 
any  interference  with  the  movement  of  the  apex  of  the 
heart,  which  would  ensue  if  the  apex  or  smaller  portion 
of  the  pericardium  were  below.  The  base  of  the  pericar- 
dium is  attached  to  a  portion  of  the  upper  surface  of  the 
diaphragm  or  "  midriflP." 

The  circulation  of  the  blood  in  the  system  is  effected 
in  the  following  manner :  The  venous  blood  throughout 
the  body  is  collected  by  two  large  veins — the  superior 
and  inferior  vena  cava ;  the  superior  vena  cava  receiving 
the  blood  from  the  head,  upper  extremities,  and  parts 
above  the  diaphragm,  while  the  inferior  vena  cava  collects 
the  venous  blood  from  those  parts  below  the  diaphragm. 
These  vessels  are  connected  with  and  discharge  their  con- 


TUE   BLOOD   AND   CIRCULATORY    ORGANS.  35 

tents  into  the  right  auricle,  wliicli  then  contracts,  and  the 
blood'is  forced  into  the  right  ventricle  through  the  right 
auriculo- ventricular  opening.  The  contraction  of  the  ven- 
tricle which  follows,  closes  the  valves  guarding  this  open- 
ing ;  the  blood,  being  then  unable  to  return  to  the  auricle, 
is  forced  out  of  the  ventricle  into  a  large  blood-vessel 
which  is  continuous  with  the  latter  cavity ;  valves  also 
guard  the  opening  into  this  vessel.  The  latter  divides 
into  two  branches,  which  carry  the  blood  to  the  lung; 
after  reaching  these  organs,  the  branches  grow  smaller 
and  exceedingly  numerous,  and  at  last  they  become  mi- 
nute vessels  known  as  capillaries,  which  surround  the  air- 
vesicles  of  the  lungs.  The  venous  blood  has  now  been 
carried  from  the  heart  to  the  lungs,  and  it  is  at  this  point 
that  the  blood  in  the  capillaries  surrounding  the  air- vesi- 
cles frees  itself  of  carbonic-acid  gas,  and  receives  in  re- 
turn oxygen  from  the  air  contained  in  the  vesicles.  The 
blood  is  now  changed  in  character :  the  color,  instead  of 
being  blue  or  venous,  is  red  or  arterial,  and  thus  enriched 
and  purified,  and  in  the  condition  to  nourish  the  tissues, 
it  is  carried  from  the  lungs  to  the  left  auricle  of  the  heart 
by  four  large  blood-vessels,  continuous  through  the  me- 
dium of  the  capillaries  which  surround  the  air-vessels  with 
the  blood-vessels  which  carry  the  venous  blood  from  the 
right  ventricle,  and  which  have  been  already  referred  to. 
The  left  auricle,  after  receiving  the  blood  from  the  lungs, 
contracts  and  its  contents  pass  into  the  left  ventricle, 
which,  being  filled,  immediately  contracts  and  forces  the 
blood  into  the  aorta  and  closes  the  left  auriculo-ventricu- 
lar  valve,  thus  preventing  the  return  of  the  blood  to  the 
auricle.  The  opening  from  the  ventricle  into  the  aorta 
is  also  protected  by  valves  which  bar  the  return  of  the 
blood  to  the  ventricles.  The  aorta,  which  begins  at  the  left 
ventricle,  is  the  main  artery  of  the  body,  and  through  it 
passes  the  arterial  blood  into  the  smaller  arteries  and  cap- 
illaries throughout  the  system.  In  these  latter  vessels 
the  nutrition  contained  in  the  blood  is  fiiven  direct  to  the 


36  PROMPT   AID   TO  THE  INJURED. 

tissues,  and  the  blood  receives  in  exchange  the  waste  ele- 
ments which  are  to  be  discharged  from  the  body.  After 
performing  this  function,  the  blood  passes  from  the  capil- 
laries into  the  veins,  the  latter  discharging  their  contents 
into  the  right  auricle  through  the  superior  and  inferior 
vena  cava,  as  already  described  ;  the  blood  has  then  made 
the  circuit  of  the  body,  or,  in  other  words,  the  circulation 
is  completed. 

The  heart  is  endowed  with  enormous  power.  Tlie 
strength  developed  in  twenty-four  hours  would  raise  a  ton- 
weight  about  one  hundred  and  twenty-five  feet  from  the 
ground. 

A  very  smooth  and  delicate  membrane  (the  endocar- 
dium) lines  the  heart,  and  is  continuous  throughout  the 
vascular  system,  forming  the  internal  coat  or  lining  (endo- 
thelium) of  the  arteries  and  veins,  and  is  the  only  coat  of 

the  capillaries. 

THE   BLOOD-VESSELS. 

The  blood-vessels,  by  which  the  blood  is  carried  through- 
out the  system  in  response  to  the  contraction  of  the  heart, 
are  divided  into  arteries,  capillaries,  and  veins. 

Arteries. — Arteries  are  the  vessels  that  carry  blood 
from  the  heart.  The  aorta  (the  largest  artery  in  the  body), 
which  is  the  beginning  of  the  arterial  system,  is  connected 
with  the  left  ventricle,  the  contents  of  which  pass  through 
the  aorta  into  the  smaller  arteries,  and  thence  into  the 
system. 

The  walls  of  arteries  are  comxDOsed  of  three  coats  or 
layers,  the  external,  the  middle,  and  the  internal.  The 
external  coat  consists  of  white  fibrous  tissue,  which  is  very 
strong  and  tough,  and  protects  the  vessel.  The  resistance 
of  the  fibrous  coat  is  well  illustrated  in  the  phenomena 
that  follow  the  ligation,  or  tying,  of  an  artery.  The  liga- 
ture, which  is  passed  around  the  vessel  and  tightly  drawn 
together  and  tied,  to  occlude  the  artery,  may  sever  the 
middle  and  internal  but  leaves  the  external  coat  prac- 
tically intact.      The  middle  coat  is    composed   of  mus- 


THE   CLOOD   AND   CIRCULATORY   ORGANS. 


37 


cular  and  yellow  elastic  tissues,  which  exert  a  normal 
mean  pressure  upon  the  contents  of  the  vessels,  and  regu- 
late the  blood-supply  to  the  different  parts  of  the  body. 
The  yellow  elastic  tissue  is  the  principal  cause  of  the 
greater  thickness  of  the  walls  of  the  arteries  compared 
with  veins;  it  also  accounts  for  the  elasticity  which  is 
characteristic  of  arteries,  and  the  fact  that  arteries  remain 
open  when  empty.  The  latter  condition  gave  rise,  years 
ago,  to  the  belief  that  these  vessels  contained  air,  and  they 
were  accordingly  named  arteries,  or  "  air- carriers." 

Arteries  pulsate,  and,  when  opened,  the  blood  escapes 
in  spurts  or  jets,  the  color  being  scarlet. 

Capillaries. — When  arteries  become  very  small  iand 
lose  their  external  and  middle  layers,  they  consist  of  but 
one  coat,  and  are  known  as  capillaries.  These  vessels  are 
often  so  minute  that  the  red  blood-corpuscles,  in  order  to 
pass  through  them,  are  obliged  to  "  double  up  "  and  pass 
through  one  by  one.  The  thinness  of  the  capillary  walls, 
and  the  slow  and  uniform  current  of  blood  in  these  ves- 


Fio.  21.— Web  of  frog's  foot,  magnified,    a,  a,  veins  ;  b,  b,  arteries,  with  capil- 
laries between  tbein 


38  PROMPT   AID   TO   THE   INJURED. 

sels,  enable  them,  as  has  already  been  described,  to  give 
direct  to  the  tissues  the  elements  of  nutrition  which  they 
contain,  and  receive  in  exchange  the  waste  of  the  body 
(Fig.  21). 

Veins. — Veins  carry  blood  tovjard  the  heart.  These 
vessels,  like  arteries,  are  composed  of  three  coats,  the  ex- 
ternal and  internal  being  similar  to  arteries.  The  middle 
coat,  however,  contains  but  very  little  yellow  elastic  tis- 
sue, which  accounts  for  the  comparative  thinness  of  the 
walls  of  veins,  and  also  the  fact  that  they  collapse  when 
empty. 

Veins,  with  the  exception  of  those  in  the  cranial,  tho- 
racic, and  abdominal  cavities,  are  supplied  with  valves, 
which  are  formed  by  a  duplication  of  the  internal  coat, 
and  allow  the  blood  to  flow  in  but  one  direction — toward 
the  heart.  This  is  essential,  as  the  current  of  blood  in 
veins  is  mainly  upward,  toward  the  heart  and  against  the 
force  of  gravity ;  and  also  as  the  pressure  of  blood  in  the 
veins  is  only  about  one  fourth  that  of  arteries.  Sometimes 
the  valves  are  rendered  useless,  and  distention  and  distor- 
tion of  the  vessel  occur,  as  in  varicose  veins  of  the  leg. 
This  condition  is  associated  with  more  or  less  prominence 
and  deformity  of  the  vein. 


CHAPTER  IV. 

RESPIRATORY  APPARATUS  AND  RESPIRATION. 

Respiration  is  the  function  wliich  provides  for  the 
proper  entrance  of  oxygen  into  the  blood,  and  the  exit 
from  the  blood  of  carbonic  acid  and  certain  waste  matter. 
The  respiratory  apparatus  for  the  transmission  of  air  to 
the  lungs  includes  the  following  structures  :  the  mouth 
and  nose,  larynx,  trachea,  bronchial  tubes,  and  air  vesi- 
cles or  cells,  the  lungs  being  chiefly  composed  of  the  lat- 
ter. An  examination  of  the  throat  will  show  two  open- 
ings, the  back  or  posterior  one  being  the  upper  part  of  the 
oesophagus  or  "gullet";  in  front  of  this,  and  just  behind 
and  below  the  base  of  the  tongue,  is  the  upper  part  of  the 
windpipe,  known  as  the  larynx  (Fig.  22) » 

The  larynx  is  a  cartilaginous  box,  containing  fibrous 
bands,  stretching  from  before  backward,  two  on  each  side, 
superior  and  inferior,  and  called  vocal  cords.  The  upper 
or  superior  pair  have  no  special  function  that  is  at  present 
known.  The  lower  or  inferior  cords  are  extremely  impor- 
tant; the  vibration  of  these  during  expiration  produces  the 
voice.  The  larynx  may  be  easily  located ;  externally  the 
prominence  known  as  the  "  Adam's  apple  "  forms  the  up- 
per portion,  the  lower  border  being  about  one  inch  and  a 
half  below.  The  opening  into  the  larynx  is  covered  by  a 
leaf-shaped  piece  of  cartilage,  known  as  the  epiglottis, 
which  prevents  food  and  other  substances  from  entering 
the  windpipe. 

The  trachea  or  "  wind-pipe  "  is  the  continuation  down- 
ward from  the  larynx  of  a  tube  about  four  or  five  inches 


40 


PROMPT   AID   TO   THE   IXJURED. 


n 


^'iG.  22.— Trachea  and  bronchial  tubes  (Sappey).  1,  2,  larynx  ;  3,  3,  trachea ; 
4,  bifurcation  of  the  trachea  ;  5.  right  bronchus  ;  6,  left  bronchus  ;  7.  bron- 
chial division  to  the  upper  lobe  of  the  right  lung  ;  8,  division  to  the  middle 
lobe  ;  9,  division  to  the  lower  lobe  ;  10,  division  to  the  upper  lobe  of  the 
left  lung ;  11,  division  to  the  lower  lobe  ;  12,  12,  12,  12.  ultimate  ramifica- 
tions of  the  bronchi ;  13,  13,  13.  13,  lungs,  represented  in  contour  ;  14,  14, 
summit  of  the  lunsrs  ;  15,  15,  base  of  the  lungs. 


long  and  three  quarters  of  an  inch  in  diameter,  composed  of 
cartilaginous  rings,  fibrous  membrane,  and  a  small  amount 
of  muscular  tissue.     These  rings  have  the  same  use  as  the 


RESPIRATORY  APPARATUS  AND   RESPIRATION.       41 

cartilag-e  forming  the  larynx — to  keep  their  respective 
walls  separated  at  all  times.  The  trachea  begins  opposite 
the  interval  between  the  spinous  processes  of  the  sixth 
and  seventh  cervical  vertebruc  and  ends  at  the  level  of  the 
spinous  process  of  tlie  fourth  dorsal  vertebra,  where  it 
divides  into  two  branches,  the  right  and  left  bronchus. 
These  tubes  after  entering  the  lungs  divide  into  a  great 
number  of  branches,  or  bronchial  tubes,  which  further  di- 
vide and  subdivide  until  they  become  exceedingly  minute 
and  end  in  little  pouches  known  as  air-cells  or  vesicles, 
which  are  very  small  and  numerous  and  will  be  again 
referred  to  in  describing  the  lungs.  The  respiratory  tract 
is  lined  throughout  by  a  mucous  membrane,  which  is 
kept  moist  and  prevents  friction  during  the  passage  of 
the  air  through  the  tube.    The  construction  of  this  mem- 


FiG.  23.— Showing  the  relative  position  of  heart  and  lungs  in  the  cavity  of 

the  chest. 


42  PROMPT  AID  TO  THE  INJURED. 

brane  in  its  upper  portion  is  peculiar,  inasmuch  as  it  has 
little  hair-like  processes  which  are  constantlj^  waving 
toward  the  outer  world,  assisting  in  preventing  the  en- 
trance into  the  lungs  of  dust  and  other  irritating  particles. 
The  lungs  (Figs.  22  and  23)  are  two  pyramidal  or  cone- 
shaped  organs,  longer  in  the  back  than  in  the  front,  situ- 
ated in  the  chest,  each  weighing  about  twenty  ounces,  the 
right  one  being  a  little  heavier  than  the  left.  They  are 
divided  by  deep  fissures  into  lobes,  the  right  lung  having 
three  and  the  left  two  lobes.  The  small  or  upper  portion 
or  apex,  extends  to  or  just  above  the  clavicle  or  collar- 
bone ;  the  larger  or  lower  portion  or  base,  descends  in 
front  to  about  the  sixth  rib,  on  the  side  to  the  eighth,  and 
in  the  back  to  the  tenth.  Each  lung  is  covered  by  a  closed 
sac  called  the  pleura,  one  of  its  layers  being  adherent  to 
the  lung  and  the  other  lining  the  chest- walls.  The  cav- 
ity of  the  pleura  contains  a  small  amount  of  fluid,  to  pre- 
vent friction  during  the  action  of  the  lungs.  The  lungs 
are  composed  of  millions  of  air-cells  or  pouches,  about  one 
two-hundredth  of  an  inch  in  diameter,  which  are  the  ter- 
mination of  the  bronchial  tubes  (Fig.  24).  The  enormous 
space  represented  by  the  air-cells  would,  if  spread  out, 
cover  an  area  of  about  six  hundred  square  feet.  This  will 
give  some  idea  of  the  vast  surface  exposed  to  the  air  pass- 
ing into  the  lungs.  The  walls  of  the  air-cells  and  of  the 
capillaries  surrounding  them  are  so  very  thin  that  the  in- 
terchange of  gases  readily  takes  place.  It  is  here,  as  has 
already  been  explained,  that  the  purification  or  change 
from  venous  to  arterial  blood  occui's.  The  respiratory  act, 
of  which  there  are  from  sixteen  to  twenty  per  minute, 
consists  of  inspiration  and  expiration.  During  inspiration 
the  air  is  carried  into  the  lungs  by  the  descent  of  the 
diaphragra,  which  exerts  a  suction -force,  and  by  the  ele- 
vation of  the  ribs,  which  increases  the  size  of  the  chest. 
Expiration,  or  the  expulsion  of  air  from  the  lungs,  is 
effected  by  elevation  of  the  diaphragm,  descent  of  the  ribs, 
and  a  partial  collapse  of  the  lungs.  Although  these  are 
the  principal  agents  of  inspiration  and  expiration,  there 


RESPIRATORY   APPARATUS   AXD  RESPIRATION.      4,3 


Fio.  24.— Terminal  bronchial  tubes  ending  in  air-cells. 

are  other  elements,  notably  the  assistance  of  certain  mus- 
cles, which,  although  of  lesser  importance,  aid  this  func- 
tion ;  and,  when  there  is  difficulty  in  breathing,  as  in  some 
diseases  of  the  lungs,  the  action  of  the  auxiliary  muscles 
about  the  neck  and  shoulders  becomes  very  apparent. 

The  lungs  during  life  are  never  entirely  collapsed,  this 
being  prevented  by  about  one  hundred  cubic  inches  of  air 
which  can  not  be  expelled,  and  is  called  "residual  air." 
Another  hundred  cubic  inches  of  air,  known  as  "  reserve 
air,"  usually  remains  in  the  lungs  after  expiration,  and 
is  used  by  these  organs  during  any  increased  physical  ex- 
ertion, as  in  I'unning,  etc.,  which  requires  an  extra  amount 
of  air. 


44  PROMPT  AID    TO   THE  INJURED. 

The  "  tidal  air  "  represents  the  amount  of  air  taken  into 
the  lungs  at  each  ordinary  inspiration,  and  consists  of 
thirty  cubic  inches.  During  violent  exercise,  however,  an 
additional  one  hundred  cubic  inches  is  taken  into  the 
lungs  at  each  inspiration,  and  is  known  as  "  comj)leniental 
air.''  The  extreme  capacity  of  the  lungs  would,  conse- 
quently, be  the  sum  of  the  residual  (100),  reserve  (100), 
tidal  (30),  and  complemental  (100)  volumes  of  air,  amount- 
ing to  three  hundred  and  thirty  cubic  inches.  The  "  vital 
capacity  "  or  "  respiratory  capacity,"  however,  is  the  amount 
which  can  be  breathed  out  after  the  deepest  possible  in- 
spiration, and  would  include,  therefore, 

Complemental  air    -        -        -  100  cubic  inches. 

Tidal  air   -----    30      " 

Eeserve  air       -        -        -        -  100      " 

Total 230  cubic  inches. 

The  air  which  we  breathe  is  composed  of  two  gases — 
oxygen  (21  parts)  and  nitrogen  (79  parts).  There  are  also, 
in  varying  quantities,  vapors,  traces  of  ammonia,  etc.,  the 
amount  depending  on  location.  It  is  the  addition  of  poi- 
sonous elements  to  the  air,  as  in  large  cities,  or  where  bad 
sanitary  conditions  exist,  that  furnish  the  causes  of  cer- 
tain diseases. 


CHAPTER  V. 

ALIMENTATION  AND   DIGESTION. 

The  alimentary  tract  or  canal  comprises  the  several 
structures  or  organs  through  whicli  food  and  drink  pass  to 
be  properly  digested  and  absorbed.  That  portion  of  the  food 
or  material  which  is  not  needed  for  nutrition,  or  can  not  be 
acted  upon  by  the  different  secretions,  is  discharged  from 
the  body.  The  alimentary  canal,  which  is  about  thirty 
feet  long,  begins  at  the  mouth  ;  then  follows  the  pharynx 
or  "  throat ; "  below  it  is  the  oesophagus  or  "  gullet,"  then 
the  stomach,  then  the  small  and  large  intestine,  the  canal 
terminating  at  the  lower  end  of  the  latter,  at  the  external 
opening  called  the  anus,  the  "fundament,"  or  "body." 

These  structures  will  be  spoken  of  separately  in  their 
order  from  above  downward.  Other  organs  upon  which 
the  function  of  digestion  depends,  and  which  are  con- 
nected with  and  discharge  their  secretions  into  the  aliment- 
ary tract,  will  be  described  in  their  proper  connection. 

Mastication  is  the  first  step  in  digestion.  This  takes 
place  in  the  mouth,  and  is  performed  by  the  teeth,*  which 
are  so  fashioned  and  arranged  that  the  food  may  be  cut, 
torn,  and  ground,  showing  that  man  is  adapted  to  all  kinds 
of  food.  In  animals,  such  as  the  cow,  that  secure  their 
food  principally  by  grazing,  the  molars  or  "  grinders  "  are 
particularly  well  developed,  while  in  dogs  and  animals 
that  depend  principally  upon  meat  for  sustenance,  the 
sharp  or  tusk-like  teeth  called  canines  are  very  promi- 
nent, and  enable  them  to  tear  the  meat  from  the  bone. 
The  teeth  are  inserted  in  the  superior  and  inferior  maxil- 

■^  The  covering  or  enamel  of  which  is  the  hanlest  structure  in  the  body. 


46 


PROMPT   AID   TO   THE   INJURED. 


lae,  or  tipper  and  lower  "jaw-bones,"  along  their  edge,  or 
alveolar  process.  There  are  thii'ty-two  teeth  in  all — six- 
teen in  each  jaw — and  arranged  in  the  manner  shown  m 
the  diagram  (Fig.  25).     That  portion  of  a  tooth  iDroject- 

ing  beyond  the 
gums  is  called  the 
crown  ;  the  root 
is  imbedded  in  the 
bone.  The  crown 
is  covered  with 
enamel,  the  hard- 
est structure  m 
the  body,  which 
protects  the  teeth 
andpreventsthem 
from  wearing  out 
as  the  result  of 
the  friction  dur- 
ing mastication. 
Acids,  if  used  too 
freely  or  too 
strong,  are  very 
destructive  to  the 
enamel,  dissolv- 
ing out  the  lime 
of  which  this 
structure  is  com- 
posed. The  use  of 
acids  is  often  indi- 
cated for  medical 
treatment ;  in  this  case,  immediately  after  the  acid  is  taken 
the  mouth  should  be  washed  out  with  a  solution  of  bicar- 
bonate of  soda  (common  baking  soda),  which  neutralizes  the 
acid.  The  teeth  cut  up  and  grind  the  food  so  that  all  parts  of 
it  may  be  exposed  to  the  different  digestive  secretions.  Im- 
proper mastication,  or  an  absence  of  teeth,  will  be  followed 
by  imperfect  digestion.     As  mastication   progresses,  the 


Fig.  25.— The  jaws  and  the  teeth.  1,  2,  incisors;  3, 
canines  ;  4,  5,  bicuspids  :  6,  7.  8.  molars  ;  a,  vein  ; 
5,  artery  ;  c,  nerve  ;  d,  vein,  artery,  and  nerve. 


ALIMENTATION    AND   DIGESTION, 


47 


food  is  made  soft  and  wet  by  an  alkaline  secretion  known 
as  saliva  or  "  spittle,"  which  is  secreted  ])y  three  salivary 
glands— parotid,  submaxillary,  and  sublingual.  These 
open  by  small  ducts  into  the  mouth  (Fig.  20).  The  par 
rotid  is  the  larg- 
est one,  and  is 
situated  behind 
the  angle  of  the 
jaWo  The  charac- 
teristic deform- 
ity in  the  dis- 
ease known  as 
"  mumps  "  is  the 
enlargement  of 
this  gland.  The 
secretion  of  the 
parotid  is  used 
mainly  to  moist- 
en the  food, 
while  that  of  the 
submaxillary 
and  sublingual 
is  more  viscid  or 


Salivary  glands  (Tracy). 


slippery,  coating  and  allowing  it  to  pass  down  the  oesopha- 
gus to  the  stomach  with  great  ease.  In  reptiles,  where 
there  is  no  mastication,  it  is  this  slimy  secretion  that  en- 
ables them  to  swallow  substances  of  very  large  bulk.  Sa- 
liva also  acts  chemically  on  food  and  changes  a  part  of  the 
starchy  matter  into  sugar.  During  mastication  the  cheeks, 
lips,  and  tongue  keep  the  food  between  the  teeth. 

The  pharynx,  or  throat,  is  the  continuation  of  the 
mouth,  and  has  no  special  digestive  action  while  the  food 
is  in  this  portion  of  the  tract. 

The  oesophagus,  or  gullet,  the  next  portion,  is  a  muscu- 
lar tube  about  eight  or  nine  inches  long,  and  is  collapsed 
when  not  in  use.  It  begins  at  the  lower  border  of  the 
pharynx,  opposite  the,  interval  between  the  spines  of  the 


48 


PROMPT  AID  TO  THE  INJURED. 


sixth  and  seventh  cervical  vertebrge,  passes  downward 
through  an  opening  in  the  diaphragm,  and  becomes  con- 
tinuous with  the  cardiac  end  of  the  stomach  opposite  the 
ninth  dorsal  vertebra.  This  tube  by  its  muscular  action 
accelerates  the  passage  of  food  downward  to  the  stomach. 
The  stomach  (Fig.  27)  is  one  of  the  j)rincipal  organs  of 
digestion.  It  appears  to  be  a  dilated  portion  of  the  aliment- 
ary canal.  In 
shape  it  some- 
what resembles 
a  bag-pipe,  hav- 
ing a  greater  and 
lesser  curvature 
it  lies  crosswise 
in  the  abdomi- 
nal cavity,  and 
has  two  open- 
ings, one  on  the 
left  side,  which 
is  continuous 
with  the  lower 
end  of  the  oesophag-us  in  the  vicinity  of  the  heart,  and 
called  the  cardiac  opening,  the  other  or  pyloric  opening 
being  on  the  right  side  ;  this  opening  is  the  beginning  of 
the  small  intestuie,  and  is  guarded  by  a  valve-like  constric- 
tion, the  pylorus,  or  "  gate-keeper." 

The  stomach  is  about  fourteen  inches  long,  five  inches 
in  diameter,  and  weighs  four  ounces ;  its  capacity  being 
about  five  pints.  It  is  composed  of  three  coats  or  layers : 
the  external,  fibro-serous ;  the  middle,  muscular ;  and  the 
internal,  mucous.  The  external  coat  prevents  friction  dur- 
ing the  movement  of  the  stomach  and  also  adds  strength. 
The  muscular  portion  produces  the  movements  necessary 
for  the  proper  digestion  of  the  contents  of  the  stomach. 
The  internal  coat  or  mucous  membrane  is  the  most  impor- 
tant layer.  In  the  substance  of  this  membrane  are  found 
numerous  little  glands  which  open  upon  the  surface  of 


YiG.  27.— The  stomach. 


ALIMENTATION  AND   DIGESTION.  49 

the  membrane.  These  peptic  or  gastric  glands  secrete  the 
gastric  juice,  which  is  so  necessary  to  digestion.  When 
foods  begin  to  enter  the  stomach,  the  contents  of  these 
glands,  which  are  considerable,  appear  on  the  surface  of 
the  membrane,  the  muscular  coat  becomes  active,  and  the 
food  is  manipulated  in  such  a  manner  that  all  portions  of 
it  shall  be  acted  upon  by  the  gastric  juice.  The  food  is 
then  changed  in  character  and  made  to  assume  a  uniform 
mass,  part  of  which  in  a  fluid  state  is  absorbed  by  the 
capillaries  of  the  stomach,  the  remaiiider  passes  down  to 
be  digested  and  absorbed  in  the  small  intestine.  The  po- 
sition and  shape  of  the  stomach  change  considerably,  par- 
ticularly during  digestion,  and  consequently  can  not  be 
well  mapped  out  externally.  However,  the  upper  or  car- 
diac opening  is  at  the  left  of  the  middle  line  of  the  body, 
just  below  the  level  of  the  junction  of  the  seventh  costal 
cartilage  and  the  sternum. 

The  stomach  is  collapsed  when  empty,  but  when  full 
it  lies  immediately  against  the  abdominal  walls,  and  also 
presses  upward,  and  may  interfere  with  the  action  of  the 
heart  and  lungs.  The  distress  that  often  occurs  after  a 
full  meal  is  often  due  to  distention  of  the  stomach. 

The  gastric  juice  is  an  acid  secretion,  differing  from  all 
of  the  other  digestive  fluids,  which  are  alkaline.  There  is 
a  large  quantity  secreted  in  twenty-four  hours,  probably 
about  fourteen  pints. 

The  small  intestine  (Fig.  28),  the  most  important  organ 
of  digestion,  is  the  next  portion  of  the  alimentary  tract, 
and  begins  at  the  pyloric  extremity  of  the  stomach.  It  is 
a  tube  about  sixteen  feet  long  and  one  inch  in  diameter, 
and  composed  of  the  three  coats  arranged  in  the  same 
manner  as  the  coats  of  the  stomach.  It  is  divided  into 
three  portions  :  the  first  and  shortest  portion  being  called 
the  duodenum,  which  is  about  eight  inches  long ;  this  is 
followed  by  the  second  portion  or  jejunum  ;  the  last  por- 
tion being  known  as  the  ileum.  The  jejunum  is  generallj^ 
empty  after  death,  and  receives  its  name  from  this  fact. 

In  the  mucous  membrane  of  this  portion  of  the  canal 
5 


50 


PROMPT  AID   TO   THE  INJURED. 


Fig.  28. — Position  of  abdominal  contents. 


are  found  glands  yielding  secretions  wliich  tend  to  dis- 
pose of  certain  articles  of  food  incompletely  digested,  or 
unaffected  by  tlie  secretion  of  the  stomach.. 

The  large  intestine  begins  on  the  right  side  of  the  body, 
and  is  continuous  with  the  ileum,  or  final  portion  of  the 
small  intestine,  and,  in  its  construction,  is  similar  to  that 
portion  of  the  canal,  although  its  diameter  is  considera- 
bly larger.  It  is  di\dded  into  ascending^  transverse,  and 
descending  colon,  sigmoid  flexture,  and  rectum,  the  lat- 
ter terminating  at  the  opening  known  as  the  anus.     The 


ALIMENTATION  AND   DIGESTION. 


51 


digestive  power  of  the  large  intestine  is  very  feeble.  It  is 
mainly  a  temporary  receptacle  for  undigested  and  refuse 
matter  which  is  to  be  discharged  from  the  body.  The  trans- 
verse colon,  which  lies  a  little  above  the  umbilicus  or 
"  navel,"  is  often  the  seat  of  intense  pain  known  as  "  colic." 
The  liver  (Fig.  29)  is  the  largest  organ  in  the  body.  It  is 
situated  in  the  abdominal  cavity,  below  the  diaphragm  and 
above  the  stomach,  principally  on  the  right  side,  its  long- 


FiG.  29.— Under  surface  of  the  liver,  showing  the  gall-bladder  and  a  section 

of  blood-vessels. 

est  diameter  being  from  right  to  left.  This  organ,  moder- 
ately filled  with  blood,  weighs  about  four  pounds,  and  its 
dimensions  are  about  as  follows  :  Transverse,  ten  inches ; 
antero-posterior,  six  inches  ;  vertical,  three  inches.  The 
surfaces  of  the  liver  are  smooth  and  the  edges  are  rounded, 
and  it  is  of  a  dark-brown  color.  In  the  normal  or  healthy 
condition  the  liver  extends  downward  on  the  right  side 
as  far  as  the  lower  border  of  the  ribs.    However,  under 


52  PROMPT  AID   TO   THE  INJURED. 

certain  conditions,  as  in  tight  lacing,  it  may  be  pressed 
below  this  point.  Above  and  on  the  same  side  the  liver 
extends  to  about  one  inch  below  the  nipple.  It  also 
reaches  to  the  left  side  of  the  median  line  of  the  body  an 
inch  and  a  half  to  two  inches  beyond  the  margin  of  the 
sternum  and  downward  to  midway  between  the  lower  end, 
of  the  breastbone  and  the  "  navel."'  The  liver  has  three 
distinct  and  separate  functions  :  First,  it  renders  very  im- 
portant aid  to  digestion,  through  the  action  of  the  bile 
which  it  secretes.  It  also  produces  sugar,  which  becomes 
chemically  changed  and  helps  to  generate  the  body-heat ; 
and,  finally,  it  discharges  from  the  body  a  small  amount 
of  waste  matter,  or,  in  other  words,  it  excretes  as  well  as 
secretes.  The  glands  of  the  skin  also  secrete  as  well  as  ex- 
crete. The  bile,  already  referred  to  as  the  secretion  of  the 
liver,  is  a  yellowish-brown  alkaline  fluid,  and  very  bitter 
to  the  taste,  and  is  discharged  from  the  liver  through  a 
small  tube,  about  the  size  of  a  goose-quill,  which  opens 
into  the  duodenum,  or  first  portion  of  the  small  intestine  ; 
in  this  manner  it  reaches  the  food  upon  which  it  is  to  act. 
Connected  with  the  under  surface  of  the  liver  is  a  pouch 
or  sac  about  four  inches  long  and  one  inch  in  width,  called 
the  gall-bladder  (Fig.  28).  It  is  formed  of  fibrous  tissue 
and  lined  with  mucous  membrane,  which  is  continuous 
with  that  lining  the  bile-ducts.  The  gall-bladder  acts  as 
a  reservoir  where  bile  accumulates,  being  expelled  during 
digestion,  when  a  large  amount  is  required.  The  secretion 
of  bile  is  continuous,  although  it  is  only  discharged  into 
the  intestine  during  digestion. 

The  pancreas  or  '•  belly  sweet-bread  "  *  (Fig.  30)  is  a 

*  "  There  are  three  kinds  of  sweet-breads,  viz. :  the  thyroid-gland, 
or  throat  sweet-bread,  which  is  tough,  almost  like  India-rubber;  the 
pancreas,  or  belly  sweet-bread,  which  is  more  tender,  and  is  quite  com- 
monly used;  and  the  thymus-gland,  or  breast  sweet-bread,  which  exists 
only  in  young  animals,  wasting  away  as  they  grow  up.  The  thymus- 
gland,  situated  just  behind  tlie  upper  portion  of  the  breastbone,,  at- 
tains its  greatest  size  in  human  beings  at  the  age  of  two  years,  and 
disappears  before  the  sixteenth  year.     Its  use  is  not  known.      This 


ALIMENTATION   AND   DIGESTION.  53 

glandular  organ  situated  at  the  upper  and  back  part  of  the 
abdominal  cavity,  opposite  the  fii'st  lumbar  vertebra,  and 


Fig.  30.— The  pancreas,  partly  cut  away,  so  as  to  show  the  duct  which  collects 
the  pancreatic  juice  and  empties  it  into  the  duodenum. 

is  mainly  on  the  left  side,  and  behind  the  stomach.  The 
pancreas  is  about  six  inches  long  and  one  inch  in 
thickness,  secretes  an  alkaline  fluid,  the  pancreatic  juice, 
and  discharges  it  through  a  small  duct  which  enters  the 
duodenum  at  the  same  opening  v>rhich  receives  the  tube 
conducting  the  bile  from  the  liver.  One  function  of  the 
pancreatic  juice  is  to  prepare  the  oil  and  fats  of  the  food  for 
absorption  by  the  process  known  as  emulsification.  As 
the  result  of  this  transformation  the  oils  and  fats  are  con- 
verted into  chyle,  a  fluid  resembling  milk  ;  this  is  absorbed 
by  the  lymphatic  vessels  along  the  intestinal  tract,  which 
are  named  lacteals  or  milk-carriers,  on  account  of  their 
white  appearance  when  filled  with  chyle.  This  fluid  is 
carried  by  the  lymphatic  vessels  to  the  receptaculum 
chyli,  a  pouch  situated  in  front  of  the  body  of  the  second 
lumbar  vertebra,  and  thence,  by  means  of  the  thoracic 
duct,  to  a  large  vein  on  the  left  upper  side  of  the  chest, 
through  which  it  reaches  the  circulation,  and  forms  a 
very  important  element  of  nutrition.  The  pancreatic 
juice  also  converts  meats,  albumin,  etc.,  into  peptones, 
and  changes  starch  into  sugar. 

gland,  taken  from  calves  and  lambs,  is  the  most  tender  and  palatable 
sweet-bread  of  all."    (Tracy.) 


CHAPTER  VI. 

KIDNUYS,  BLADDER,  SKIN,  SPLEEN. 
KIDXEYS. 

The  "kidneys  (Fig.  31)  are  excretory  organs,  and  consist 
of  two  large  tubular  glands  situated  in  tlie  back  part  of  the 
abdominal  cavity  in  the  lumbar  region  on  each  side  of  the 
spinal  column.  They  extend  from  tbe  eleventh  rib  down- 
ward nearly  to  the  upper  borders  of  the  pelvis  or  "haunch- 
bones."  The  right  kidney  is  a  little  lower  than  the  left. 
They  are  bean-shaped,  about  four  inches  in  length  and  two 
in  width,  and  each  weighing  about  four  to  six  ounces.  It 
will  be  remembered  that  the  excretory  organs  simply  ab- 
stract from  the  blood  elements  of  waste  tissue,  and  dis- 
charge the  same  from  the  body.  They  exert  very  little 
change  in  this  material,  but  act  mainly  as  an  outlet  for 
it.  The  material  excreted  by  the  kidneys  is  known  as 
the  urine,  and  consists  of  water  holding  in  solution  waste 
and  poisonous  matter,  as  urea,  etc.  The  amount  of  urine 
removed  by  the  kidneys  in  twenty-four  hours  is  about 
three  pints.  It  is  an  acid  fluid  when  first  discharged, 
but  usually  becomes  alkaline  as  the  result  of  decomposi- 
tion. The  ureters  are  two  small  tubes  (one  from  each  kid- 
ney) about  the  size  of  a  goose-quill,  and  sixteen  or  eighteen 
inches  long,  which  conduct  the  urine  from  the  kidneys 
to  the  bladder,  entering  that  organ  at  its  lower  portion. 
Oftentimes,  small  concretions,  varying  in  size  from  grains 
of  sand  to  those  of  larger  diameter,  called  renal  calculi, 
familiarly  known  as  "  gravel,"  are  formed  in  the  kidneys, 
and  during  the  passage  of  these  little  bodies  through  the 


KIDNEYS,  BLADDER,  SKIN,  SPLEEN. 


55 


ureteiJS  on  the  way  to 

the  bladder,  the  larger 

ones  may  cause  such 

irritation    and  press- 
ure along  these  tubes 

as     to     produce    the 

most    intense     pain. 

This    condition    has 

received  the  name  of 

renal  or  kidney  colic. 

Sudden    and  intense 

pain  on  the  side, 
along  the  course  of 
the  ureter  involved, 
would  be  the  princi- 
pal symptom.  The 
sudden  beginning  of 
the  pain  would  de- 
note the  entrance  of 
one  or  more  of  the 
little  bodies  into  the 
ureter,  and  the  abrupt 

ending  of  the  pain  in-  

dicate  that  they  had  vr    o.    ^^  .■    ^      .■       ^     .  ■. 

^    ,  -^  Fig.  31.— Vertical  section  of  a  kidney,  showing 


the  minute  tubes  which  excrete  the  urine; 
also  the  pelvis,  or  basin  of  the  kidney,  which 
receives  the  urine  before  it  passes  do\^Tiward 
to  the  bladder.  The  beginning  of  a  ureter  is 
also  shown. 


entered  the  bladdei 

THE  BLADDER, 

The  bladder,  or 
reservoir  which  re- 
ceives the  urine,  is  a  sac  having  three  coats  or  layers  ar- 
ranged in  a  manner  similar  to  that  of  the  layers  of  the 
stomach  and  intestine— fibro-serous  externally,  muscular 
tissue  forming  the  middle  coat,  and  the  internal  being  com- 
posed  of  mucous  membrane.  When  moderately  distend- 
ed the  bladder  is  about  five  by  three  inches  and  contains 
about  one  pint ;  however,  it  may  hold  considerably  more. 
When  a  sufficient  amount  of  urine  has  accumulated,  it  is 


56 


PROMPT   AID   TO   THE   INJURED. 


discharged  from  the  bladder,  mainly  by  the  contraction  of 
its  muscular  walls  :  this  act,  which  in  the  beginning  is 
voluntary,  usually  occurs  four  or  five  times  during  the 
twenty-four  hours.  The  bladder  is  situated  in  the  lower 
part  of  the  pelvic  cavity,  just  behind  the  pubic  bone. 

SKIN   (INTEGUMENT). 

This  structure,  which  covers  all  portions  of  the  body 
and  protects  the  deeper  parts,  is  an  organ  of  excretion 
and  secretion,  and  also  of  the  sense  of  touch,  the  lat- 
ter function  being  highly  developed  at  the  finger- 
ends.     The  power   of   absorption  through  the  unbroken 

skin  of  the  hu- 
man being  is 
generally  be- 
lieved to  be  ex- 
tremely slight. 
The  skin  is 
composed  of 
two  layers,  the 
outer  and  in- 
ner ;  the  form- 
er being  called 
the  epidermis, 
cuticle,  scarf, 
or  false  skin, 
and  the  latter 
receiving  the 
name  of  derma, 
corium,  or  true 
skin  (Fig.  32). 
The  epidermis 
contains  nei- 
ther blood-ves- 
sels nor  nerves, 
and  is  simply 
a  scaly  layer 
which  protects  the  true  sl-riu  underneath,  and  becomes  easi- 


Fig.  32. — Vertical  section  of  the  skin,  magnified,  a, 
Scarf-skin  ;  b,  pigment-cells  ;  c,  papilla  ;  d,  true 
skin ;  e,  f.  fat-cells  :  g,  sweat-glands  ;  /?,  outlets  of 
sweat-glands  ;  i,  their  openings  on  the  surface  of 
the  skin  ;  k,  hair-follicle  ;  I,  hairs  projecting  from 
the  skin  ;  m,  hair-papilla  ;  n,  hair-bulb  ;  o,  root  of 
hair  ;  p,  openings  of  oil-glands. 


KIDNEYS,   BLADDER,   SKIN,   SPLEEN.  57 

ly  detached  from  it  uuder  certain  conditions.  A  blister 
shows  the  separation  of  the  two  layers  of  skin,  with  a 
small  amount  of  fluid  between  them.  The  derma  or  true 
skin  is  richly  supplied  with  blood-vessels,  nerves,  and  lym- 
phatics, and  in  this  layer  reside  the  functions  above  alluded 
to.  The  skin  contains  millions  of  minute  tubes  known  as 
sudoriferous  or  "sweat"  glands  ;  also  the  sebaceous  or  fat 
glands,  and  hair-follicles.  The  sweat-glands,  by  constantly 
removing  from  the  body  a  watery  vapor  known  as  per- 
spiration or  "  sweat,''  in  which  they  are  aided  by  evai^ora- 
tion,  help  to  regulate  the  body  temperature.  It  is  the  won- 
derful activity  of  these  organs,  and  the  large  quantity  of 
perspiration  thrown  off,  that  enables  one  to  endure  a  very 
high  degree  of  dry  heat.  In  addition  to  the  action  just 
described,  they  have  the  important  function  of  eliminating 
from  the  system  waste  material  similar  to  that  excreted 
by  the  kidneys  (urea)  ]  for  this  reason  the  skin,  through 
the  sweat-glands,  is  regarded  somewhat  as  a  supplement- 
ary organ  to  the  kidneys.  In  warm  weather,  when  the 
skin  is  most  active,  the  amount  of  perspiration  is  largely 
increased  and  the  amount  of  urine  correspondingly  dimin- 
ished, while  in  winter  the  condition  is  reversed.  An  aver- 
age amount  of  loerspu^ation  formed  in  twenty-four  hours 
is  about  two  joints.  It  is  very  important  that  the  similarity 
in  action  of  the  skin  and  kidneys  should  be  recognized,  and 
that  the  one  may  be  induced  to  relieve  the  other,  for,  when 
the  kidneys  are  impaired,  either  temporarily  or  permanent- 
ly, much  relief  may  be  obtained  by  stimulating  the  skin. 

The  importance  of  keeping  the  skin  in  a  healthy  con- 
dition by  proper  clothing,  exercise,  and  bathing,  can  not  be 
overestimated.  The  product  of  the  fat  or  sebaceous  glands 
protects  the  skin,  and  keeps  it  more  or  less  oily  and  pliable. 

With  few  exceptions  the  hair-follicles  are  found  in  all 
portions  of  the  body ;  in  some  parts,  however,  the  hair  is 
BO  fine  as  to  be  hardly  noticeable.  The  hairs,  and  also  the 
nails,  are  regarded  as  appendages  of  the  skin,  affording 
additional  protection. 


58  PROMPT   AID   TO   TEE   INJURED. 

SPLEEX. 

Ttie  spleen  is  a  soft  and  spongy  organ,  situated  in  the 
abdominal  cavity,  on  the  left  side,  near  the  cardiac  end  of 
the  stomach,  and  extends  from  the  ninth  to  the  eleventh 
ribs.  It  measui^es  about  five  inches  long  by  three  inches 
^T.de,  and  two  inches  thick,  weighing  about  eight  ounces. 
It  is  called  a  ductless  gland,  not  having  the  characteristics 
of  a  secretory  or  an  excretory  organ.  Its  function  has  not 
yet  been  definitely  settled 


CHAPTER  VII. 

NERVOUS  SYSTEM. 

The  activity  of  the  mind  and  body,  the  correct  working 
of  the  several  organs,  and  the  sympathy  existing  between 
the  different  paints  of  the  organism,  depend  upon  the  nerv- 
ous system,  which  is  divided  into  the  cerebro-spinal  axis 
and  the  sympathetic  system. 

Cerebro-Spinal  System. — Tliis  system  comprises  the 
brain,  spinal  cord,  and  nerves  (Fig.  34). 


Fig.  33. — The  brain  inclosed  in  its  membranes,  and  the  skull :  a,  b,  c,  convolu- 
tions of  the  cerebrum;  d,  the  cerebellum  ;  e,  medulla  oblongata  ;  /,  upper 
end  of  the  spinal  cord  ;  g,  pons  Varolii  •  h,  i,  k,  central  parts. 

The  brain  (Fig.  35),  which  is  the  seat  of  the  intellect, 
the  will,  and  the  emotions,  is  contained  in  the  cranial  cav- 


60  PROMPT   AID   TO   THE   INJURED. 


Fig.  34.— The  cerebro-spinal  system  of  nerves 


NERVOUS  SYSTEM. 


61 


ity  (Fig.  33).  It  is  divided  ino  four  principal  parts,  viz., 
the  cerebrum,  the  cerebelhim,  the  pons  Varolii,  and  the 
medulla  oblongata. 


Cerebrum. 


Pons  Varolii 


Medulla 
oblongata. 


Cerebelhim. 


Fio.  35.— Under  surface  of  brain,  showing  the  cerebrum,  cerebellum,  pone 

Varolii,  aud  medulla  oblongata. 


The  cerebrum  (Fig.  86)  constitutes  over  four  fifths  of 
the  entire  brain.  It  is  ovoid  in  form,  being  divided  into 
two  portions  by  a  deep  groove,  running  from  before  back- 
ward, and  occupies  the  upper  and  greater  portion  of  the 
cranial  cavity.  It  is  composed  of  gray  and  white  matter, 
about  the  consistence  of  ''  sweet-breads "  ;  the  white  mat- 
ter forms  the  internal  and  greater  portion  of  the  cerebrum, 
the  gray  matter  forming  the  external  layer.     The  surface 


62 


PROMPT   AID   TO   THE  INJURED. 


of  the  cerebrum  is  not  smooth,  hut  thrown  into  folds,  called 
convolutions.     This  arrangement  increases  its  area,  and 

consequently  its  func- 
tion. The  convolutions 
are  superficial  and  not 
so  well  marked  in  the 
braui  of  an  infant,  but 
grow  deeper  and  larger 
until  the  brain  has 
reached  its  full  develop- 
ment, at  about  the  for- 
tieth year.  The  cere- 
brum is  the  seat  of  the 
mind  and  of  its  different 
functions  which  distin- 
guish man  from  the  low- 
er animals.  The  exact 
point  in  the  cerebrum 
where  these  functions 
are  located  may  at  some 
future  time  be  definitely 
settled,  considerable  progress  having  already  been  made 
in  this  direction. 

The  cerebellum,  or  little  brain,  corresponds  in  structure 
quite  closely  to  the  cerebrum,  with  which  it  is  connected, 
being  situated  beneath  it  and  at  the  back  part  of  the  cra- 
nial cavity.  The  cerebellum  regulates  and  keeps  in  perfect 
harmony  the  different  movements  of  the  body,  particu- 
larly of  the  extremities  (Figs.  34  and  35). 

The  pons  Varolii,  or  "  bridge,"  is  a  small  portion  of  the 
brain,  and  situated  in  front  of  the  cerebellum.  It  binds 
together  the  different  parts  of  the  brain  already  enumer- 
ated, and  also  transmits  the  different  nerves  passing  be- 
tween the  brain  and  spinal  cord  (Fig.  35). 

The  medulla  oblongata  is  below  the  pons  Varolii,  and 
appears  to  be  the  upper  end  of  the  spinal  cord  somewhat 
expanded.  In  the  substance  of  this  organ  about  three 
fourths  of  the  motor-nerve  fibers  passing  from  the  brain 


Fig.  36.— Upper  surface  of  the  cerebrum, 
showing  the  convolutions  of  the  brain 
and  its  double  structure. 


NERVOUS  SYSTEM.  63 

to  the  spinal  cord  cross  cacli  other  or  decussate,  decussa- 
tion of  the  remainder  taking  place  in  the  spinal  cord ; 
consequently  a  motor-nerve  fiber  having  its  origin  in 
the  right  side  of  the  brain  crosses  to  the  left  when  it 
reaches  the  medulla  oblongata,  and  becomes  identified 
with  the  left  side  of  the  spinal  cord,  and  furnishes  motion 
to  that  side  of  the  body.  This  will  explain  why  an  injury 
to  one  side  of  the  brain  will  produce  paralysis  on  the  op- 
posite side  of  the  body,  as  in  apoplexy.  The  medulla  also 
presides  over  the  function  of  respiration. 

The  human  brain  weighs  about  fifty  ounces,  being 
heavier  than  that  of  any  of  the  lower  animals,  with  the 
exception  of  the  elephant  and  the  w^hale.  The  brain  of 
the  elephant  weighs  about  eight  pounds,  that  of  the  whale 
somewhat  less.  The  human  brain  probably  reaches  its 
highest  development  at  about  the  fortieth  year.  After  this 
period  it  gradually  diminishes  in  weight,  about  one  ounce 
in  ten  years,  so  that  in  old  age  both  the  size  and  function 
of  the  brain  are  considerably  lessened. 

The  deep  convolutions  spoken  of  are  characteristic  of 
the  human  brain,  being  present  in  a  lesser  degree  in  the 
lower  animals. 

The  spinal  cord  is  that  portion  of  the  cerebro-spinal 
axis  contained  in  the  spinal  or  vertebral  canal.  It  is  cylin- 
drical in  shape,  extending  downward  from  the  medulla 
oblongata  to  the  first  lumbar  vertebra,  being  from  fifteen 
to  eighteen  inches  long,  and  is  composed  of  gray  and 
white  matter,  the  white  matter,  however,  being  outside 
and  consisting  of  nerve-fibers  which  act  as  conductors  of 
sensory  and  motor  influence.  The  motor  fibers  of  the 
cord  are  found  in  the  front  and  at  the  sides,  and  the  sen- 
sory fibers  in  the  back  or  posterior  portion. 

The  spinal  cord,  through  the  medium  of  its  branches, 
to  be  presently  described,  transmits  nerve  influence  to  and 
from  the  brain.  It  is,  to  a  certain  extent,  capable  of  acting 
as  a  separate  nerve-center  and  generating  force  independ- 
ently of  the  brain. 

Nerves  are  classified  as  those  having  a  motor  and  sen- 


^4:  PROMPT   AID   TO   THE   IXJURED. 

sory  influence,  and  nerves  of  special  sense.  Motor  nerves 
are  fibers  ayMcIi  conduct  from  the  brain  (and  to  a  certain 
extent,  from  the  spinal  cord)  the  necessary  force  to  ani- 
mate muscular  fibers,  thus  xDroducing  the  different  move- 
ments of  the  body ;  motor  nerves  therefore  transmit  an  in- 
fluence from  within  outward.  Sensory  nerves  are  fibers 
which  convey  from  different  portions  of  the  body  certain 
sensations  to  the  brain.  For  instance,  when  a  finger  is 
burned  or  injiu'ed,  the  sensation  of  pain  experienced  indi- 
cates an  impression  made  upon  a  sensory  nei've  at  the 
point  of  injuiy,  and  which  is  received  at  the  great  nerve- 
center  or  brain.  Neiwes  of  special  sense,  as  the  name  im- 
plies, have  separate  functions.  They  do  not  transmit 
motion  or  common  sensation  just  described,  but  preside 
over  the  special  senses,  as  sight,  hearing,  taste,  etc. 

Cranial  Nerves. — From  the  under  snrface  or  base  of 
the  brain,  on  each  side,  are  given  off  twelve  nerves,  which 
are  known  as  the  twelve  pairs  of  cranial  nerves.  They  are 
composed  of  white,  glistening  fibers,  and  are  numbered 
anatomically  from  before  backward.  These  nerves  are  so 
very  important  that  a  brief  description  of  them  will  be 
necessary. 

The  first,  or  olfactory  nerves,  supply  the  special  sense 
of  smell,  and  are  distributed  to  the  mucous  membrane 
lining  the  nose.  The  second,  or  optic  nerves,  supply  the 
special  sense  of  sight,  and  are  distributed  to  the  eyes.  The 
third,  fourth,  and  sixth  are  motor  nerves,  and  animate 
the  muscles  moving  the  eyeballs.  The  fifth  are  the  largest 
of  the  cranial  nerves,  and  have  a  mixed  function  ;  the 
sensitive  branches  supply  common  sensation  to  the  teeth, 
nearly  all  of  the  face,  the  mucous  membrane  of  the  eye, 
nose,  and  portions  of  the  mouth  and  throat  ;  the  motor 
branches  supply  the  muscles  of  mastication.  The  seventh 
supply,  with  the  exception  of  those  directly  concerned  in 
mastication,  the  muscles  of  the  face  with  motion.  A  small 
branch  supplies  the  special  sense  of  taste  to  the  anterior 
portion  of  the  tongue.  The  eighth,  or  auditory  nerves, 
furnish  the  sense  of  hearing.     The  ninth  supply  the  pos- 


NERVOUS  SYSTEM. 


C5 


Nerves  to 
left  arm. 


Nerves  to 
right  arm. 


terior  j^art  of  the  tongue  with  the  special  sense  of  taste, 
and  also  common  sensation  to  the  tongue  and  pharynx. 
The  tenths  which  at  its  origin  is  a  sensory  nerve,  re- 
ceives motor  branches 
from  the  seventh, 
eleventh,  and  twelfth, 
and  first  and  sec- 
ond cervical  nerves. 
The  motor,  sensory, 
and  mixed  branches 
of  this  nerve  go  to 
the  pharynx,  larynx, 
oesophagus,  heart, 
stomach,  small  intes- 
tine, liver,  spleen,  and 
kidneys. 

The  eleventh  fur- 
nish part  of  the  mo^ 
tor  supply  to  one 
muscle  of  the  neck  in 
front  and  to  a  muscle 
of  the  shoulder  and 
neck  posteriorly  (each 
side).  By  the  branches 
which  join  the  tenth, 
these  nerves  supply  the 
muscles  of  the  larynx 
concerned  in  the  pro- 
duction of  the  voice  ; 
they  also  contribute  to 
the  regulation  of  the 
action  of  the  heart. 
The  twelfth  are  motor  nerves,  and  preside  over  the  move- 
ments of  the  tongue. 

The  cranial  nerves  that  supply  structures  outside  of 
the  cranial  cavity  pass  through  small  openings  in  the 
skull  on  the  way  to  their  destination. 


Nerves  to 
front  of 
left  leg. 

Nerves  to 
back  of 
left  legr. 


Nerves  to 
front  of 
right  leg. 

Nerves  to 
back  of 
right  leg. 


Fig.  37.— Brain  and  spinal  cord,  with  the  thir- 
ty-one pairs  of  spinal  nerves. 


GQ 


PROMPT   AID   TO   THE   IXJURED. 


Spinal  Nerves  (Fig.  37). — There  are  thirty-one  nerves 
given  off  from  each  side  of  the  spinal  cord,  each  nerve 
forming  with  its  fellow  on  the  opposite  side  a  pair  similar 
to  the  arrangement  of  the  cranial  nerves.  They  also  re- 
semble those  nerves  in  appearance.  Each  pair  of  nerves 
are  composed  of  fibers  arising  from  the  anterior  and  poste- 
rior columns  of  the  cord,  and  consequently  contain  motor 
and  sensory  fibers.  At  a  short  distance  from  the  spinal 
cord  the  nerves  divide  into  anterior  and  posterior  branch- 
es, the  anterior 
branches  supply- 
ing the  trunk  and 
extremities,  dia- 
phragm, and  cer- 
tain organs.  The 
posterior  or  small- 
er, branches  sup- 
ply principally  the 
muscles  and  skin 
of  the  back. 

The  brain  and 
spinal  cord  are 
each  protected  by 
a  closed  sac,  sur- 
rounding them, 
after  the  manner 
of  the  pericardium 
which  envelops 
the  heart,  and  the 
pleura  covering 
the  lungs. 

The  portion  of 
the  nervous  system  just  described  presides  over  the  func- 
tions of  animal  life — the  intellect,  general  sensation,  the 
special  senses,  and  motion. 

Sympathetic   System.— Organic  life,  or  that  which 
relates  to  secretion  and  excretion,  the  proper  distribution 


Fig.  38. — The  s^Tiipatlietic  or  ganglionic  nervous 
system. 


NERVOUS  SYSTEM.  (J7 

of  bloed  and  nutrition  to  the  tissues,  the  control  of  the 
involuntary  muscular  tissue  which  is  found  in  the  ali- 
mentary tract,  blood  vessels,  etc.,  must  be  unaffected  by 
the  outside  world.  Were  it  subject  to  the  will,  and  to  such 
influences  as  govern  the  cerebro- spinal  axis,  the  functions 
of  organic  life  would  soon  be  disturbed,  and  the  most  seri- 
ous consequences  would  ensue.  This  system  must  work 
on  uninterruptedly,  in  health  and  disease,  night  and  day — 
at  all  times.  For  this  purpose  Nature  has  supplied  a  sepa- 
late  and  independent  nerve-force  known  as  the  sympa- 
thetic or  ganglionic  system  (Fig.  38),  which  consists  of  a 
series  of  little  bodies  or  ganglia  which  begin  at  the  under 
surface  of  the  brain,  and  continue  downward  on  each  side 
of  the  spinal  or  vertebral  column  to  its  lower  extremity. 
Although  this  system  is  independent  of  the  cerebro-spinal 
axis,  in  its  special  function,  it  communicates  with,  and  ac- 
companies the  cranial  and  spinal  nerves  to  organs  which 
are  supplied  by  both  systems.  It  also  brings  the  different 
organs  in  communication  with  each  other,  and  admits  of 
the  sympathy  which  exists  between  them.  This  relation 
between  the  different  organs  explains  why  a  disordered 
stomach  will  produce  headache,  or  why  death  may  follow 
a  blow  at  the  pit  of  the  stomach,  which  injures  the  large 
sympathetic  ganglia  back  of  this  organ,  the  shock  con- 
veyed to  the  heart  being  so  great  as  to  arrest  its  action. 


CHAPTER  Yin. 

BANDAGES,  DRESSINGS,  ETC. 

Bandages  are  used  to  retain  dressings  in  position,  arrest 
haemorrliage,  and  support  and  render  immovable  different 
portions  of  the  body.  For  general  use  tliey  are  divided 
into  roller,  and  Esmarch  or  triangular  bandages. 

The  roller  bandage  when  properly  applied  is  not  only 
a  valuable  means  of  employing  this  form  of  dressing,  but 
is  also  attractive  in  appearance ;  considerable  sMll,  how- 
ever, is  essential  in  order  to  make  its  application  effect- 
ive. The  choice  and  preparation  of  material  necessary  for 
its  construction  render  its  use  impossible  at  all  times  and 
places ;  for  this  reason  the  Esmarch  or  triangular  band- 
age, which  can  be  made  from  a  handkerchief,  shu't,  or 
some  other  material  that  can  be  ]3rocui'ed  at  once,  is  ac- 
cepted as  being  best  adapted  for  emergencies. 

The  materials  utilized  for  bandages  include  linen,  flan- 
nel, calico,  and  muslin.  Rubber  tissue  is  also  often  used 
by  surgeons  for  special  purposes,  as  support  in  varicose 
veins  of  the  leg,  and  flannel  where  warmth  is  required. 
For  ordinary  purposes,  unbleached  muslin  of  a  medium 
textiu'e  is  the  best  fabric  that  can  be  employed. 

Bandages  should  not  contain  starch,  nor  should  they 
be  pieced,  as  either  condition  produces  considerable  irrita- 
tion of  the  skin,  and  also  prevents  their  proper  apphcation. 

Roller  bandages  are  usually  made  from  thi'ee  to 
eight  yards  long  and  from  one  to  six  inches  wide,  depend- 
ing upon  the  part  of  the  body  to  which  they  are  to  be 


BANDAGES,   DRt:SSIN(;S,   ETC. 


69 


applied— one  inch  for  tlie  fingers,  three  inches  for  the  up- 
per extremity,  four  inches  for  the  lower  extremity,  and 
five  or  six  inches  for  the  chest  and  abdomen.  Bandages 
should  always  be  torn  from  the  piece,  unless  the  material 
from  which  they  are  constructed  is  very  thin.  The  selv- 
edge along  the  edge  of  the  fabric  should  always  be  re- 
moved before  the  bandages  are  rolled. 

In  rolling  a  bandage  the  following  directions  are  to 
be  observed  :  One  end  of  the  strip  should  be  folded  for 
a  distance  of  about  six  inches  ;  this  lap  should  then  be 
folded  on  itself,  and  the  process  continued  until  the  folded 
portion  assumes  the  form  of  a  roll  or  cylinder,  which  should 
then  be  held  by  the  thumb  and  index-finger  of  the  right 
hand,  the  loose  strip 
of  the  bandage  ly- 
ing over  the  back 
of  the  left  hand  be- 
tween the  thumb 
and  index  -  finger. 
The  hand  holding 
the  bandage  should 
now  be  turned  to- 
ward the  right,  when 
the  roll  will  begin 
to  increase  in  size  ; 
this  manipulation  is 
to  be  continued  un- 
til the  bandage  is 
entirely  rolled  ;  it  is 
very  important  that  the  bandage  should  be  wound  tightly, 
particularly  at  the  beginning,  otherwise  it  can  not  be 
evenly  adjusted  (Fig.  39). 

A.  bandage  usually  has  one  head  or  roll,  although  it 
may  be  made  double-headed  (by  rolling  from  both  ends) 
for  special  purposes,  as  in  the  knotted  bandage. 

The  application  of  a  bandage  should  always  be  com- 
menced by  laying  the  outer  siu-face  against  the  skin.     If 


Fig.  39.— Method  of  rolling  a  bandage. 


70  PROMPT   AID   TO   THE   INJURED. 

used  to  retain  a  dressing,  it  may  be  begun  at  any  part 
of  an  extremity,  the  soft  dressing  underneath  prev^enting 
any  undue  interference  with  the  circulation  ;  but  when 
the  bandage  is  applied  for  support  or  pressure,  it  must  be 
commenced  at  the  extreme  end  of  the  limb  and  bandaged 
toward  the  body,  otherwise  the  constriction,  particularly 
if  the  bandage  is  drawn  tightly,  may  be  followed  by  stran- 
gulation and  gangrene  of  the  tissues  below  the  bandage. 
A  bandage  should  be  closely  applied  to  a  limb,  but  not 
made  tight,  and  the  degree  of  pressm^e  should  be  uniform. 
Should  any  evidence  of  strangulation  occur,  which  would 
be  manifested  by  swelling  and  discoloration,  and  also  a 
reduced  temperature  of  the  limb  below  the  bandage,  the 
dressing  must  be  at  once  removed.  It  is  partly  for  this 
reason  that  the  toes  and  the  ends  of  the  fingers  are  left 
uncovered  in  bandaging  an  extremity — that  thej'"  may 
serve  as  an  index  to  the  general  circulation  of  the  arm  or 
the  leg.  A  bandage  applied  diy  and  wetted  afterward  is 
followed  by  considerable  shrinking,  and  sometimes  stran- 
gulation of  the  tissues. 

A  bandage  should  not  be  applied  to  a  limb  until  the  lat- 
ter is  placed  in  the  position  in  which  it  is  to  remain.  For 
example,  an  arm  should  never  be  bandaged  while  straight, 
and  then  bent  afterward,  otherwise  serious  constriction 
will  be  made  at  the  flexure. 

For  ordinary  use  the  application  of  the  roller  bandage  is 
divided  into  three  methods  :  the  circular^  the  spiral  reverse^ 
and  ih.Q  figure  of  8  (the  latter  including  spica  bandages). 

The  circular  variety  is  the  simplest  manner  in  which  a 
roller  bandage  can  be  applied,  and,  when  possible,  should 
always  be  employed.  It  is  indicated  when  the  diameter  of 
the  part  is  nearly  uniform,  and  consists  of  a  succession  of 
circular  turns  from  below  upward,  each  turn  overlapping 
the  upper  third  of  the  one  below. 

The  spu'al  reverse  bandage  is  used  where  the  diameter 
of  the  part  becomes  increased  or  decreased  in  size,  as  in  the 
forearm  (Fig.  40). 


BAiNDAGES,   DRESSINGS,   ETC. 


71 


The^  figure-of-8  bandage  is  used  about  joints  or  wliere 
an  abrupt  enlargeoicnt  occurs.  The  hip  and  shoulder 
spica  are  varieties  of  this 
bandage.  The  manner  in 
which  the  different  layers 
cross  each  other  give  to  it 
something  of  the  ai)pear- 
auce  of  a  figure  of  8 ;  hence 
the  name. 

In  order  to  illustrate  the 
different  varieties  of  band- 
ages named  above,  it  may 
be  supposed,  for  example, 
that  the  left  lower  extrem- 
ity, including  the  hip,  is  to 
be  bandaged,  which  gener- 
ally necessitates  the  use  of 
the  different  forms  already 
enumerated. 

Several  bandages,  hav- 
ing a  width  of  about  three  and  a  half  to  four  inches, 
are  procured.  The  operator  places  himself  directly  in 
front  of  the  limb  to  be  bandaged,  which  is  somewhat  ele- 
vated, the  patient  being  seated  or  in  bed.  The  operator, 
holding  the  bandage  in  his  right  hand,  unrolls  about  six 
inches  of  it,  the  outer  side  of  which  is  laid  obliquely  across 
the  dorsum  or  top  of  the  foot  from  within  outward,  and 
continued  around  the  lower  part  of  the  ankle  to  the  inner 
side,  and  then  again  over  the  dorsum  of  the  foot,  crossing 
the  first  portion  applied,  and  carried  downward  to  the  base 
of  the  toes  on  the  outer  side ;  from  this  point  two  or  three 
circular  turns  are  made  around  the  foot,  extending  up- 
ward, and  thence  again  to  the  ankle,  where  the  circular 
form  is  employed  until  the  calf  of  the  leg  is  reached.  If 
the  circular  turns  are  continued  at  this  point,  the  lower 
border  will  be  seen  to  gape  ;  for  this  reason  the  spiral  re- 
verse method  should  now  be  substituted  (Fig.  40).     From 


Fig.  40.— Spiral  reverse  bandage. 


72  PROMPT   AID  TO   THE   INJURED. 

the  last  circular  turn,  the  bandage  should  be  carried  spirally 
upward  and  outward  for  about  five  or  six  inches.  The 
operator  then  presses  with  the  thumb  of  his  left  hand  the 
body  of  the  bandage  against  the  median  line  of  the  leg,  to 
prevent  it  from  slipping,  while  the  right  (holding  the  band- 
age) is  brought  toward  the  operator  with  a  slight  inward 
turn,  thus  folding  downward  (reversing)  the  upper  edge  of 
the  bandage  to  a  point  just  above  the  thumb  of  the  left 
hand,  and  held  for  a  moment  in  this  manner  until  the  dis- 
engaged fingers  of  the  left  hand  are  carried  behind  the  leg 
and  receive  the  roller  or  cylinder  from  the  right,  which, 
now  being  free,  retains  the  fold  or  reverse  in  position  until 
the  bandage  is  again  passed  to  it  for  another  reverse.  This 
is  to  be  continued  (each  turn  overlapping  the  upper  third 
of  the  turn  below)  until  the  portion  of  the  leg  above  the 
calf  is  reached,  where  the  circular  turns  can  be  made  up 
to  the  lower  edge  of  the  patella  or  "  knee-cap,"  where  the 
figure-of-8  bandage  is  begun  in  the  follov^ing  manner  : 
after  a  circular  turn,  the  bandage  is  carried  obliquely  over 
the  patella  from  within  outward  and  upward,  making  a 
circular  turn  above  the  knee,  then  to  the  inner  side  of  the 
leg  and  downward  and  outward,  crossing  the  portion  of 
the  bandage  over  the  patella.  A  circular  turn  is  now 
made  around  the  knee  below  the  patella  (to  retain  the 
spu'al  or  oblique  turns  already  made),  and  then  carried 
again  obliquely  upward  and  outward,  overlapping  the  up- 
per half  or  one  third  of  the  preceding  turn  in  this  direc- 
tion, and  continued  in  this  manner  until  the  entire  knee 
is  covered.  Above  the  knee,  the  circular  form  can  be  used 
for  a  short  distance  and  then  changed  to  a  reverse  as  it 
ascends  the  thigh,  and  continued  to  a  point  just  below  the 
groin  ;  from  this  point  the  application  of  the  hip  spica  be- 
gins, the  bandage  is  carried  upward  and  around  the  hip 
to  the  opposite  side  of  the  body,  just  above  the  great  tro- 
chanter of  the  right  femur  ;  this  bony  prominence  marks 
the  upper  extremity  of  the  thigh-bone,  and  can  readily  be 
found,  particularly  if  the  patient  be  made  to  move  the  leg. 


BANDAGES,    DRESSINGS,   ETC. 


73 


Follo^iving  this  course,  the  bandage  is  carried  over  the 
belly  to  the  point  where  it  started  from  (left  tliig-h),  cross- 
ing the  first  turn  and  passing  downward  and  backward 
around  the  thigh.  This  procedure  is  to  be  repeated  in  an 
ascending  manner  until  the  hip  is  covered.  The  bandage, 
when  applied,  should  not  extend  above  the  upper  border 
of  the  haunch-bones  (crest  of  the  ilium).  It  will  be  noticed 
that,  in  bandaging  the  foot,  the  toes  and  heel  are  left  un- 
covered. This  is  the  usual  mode  of  applying  the  bandage, 
unless  an  injury  exists  at  these  parts. 

The  shoulder  spica  is  applied  in  a  manner  similar  to 
the  spica  of  the  hip.     When  the  bandage  is  carried  to  the 
opposite  side,  it  passes  beneath  tlie  arm  and  back  again 
over     the     shoulder,     from 
where  it  began.     It  also  is 
an  ascending  bandage  (Fig. 
41).     In  the  spica  bandage 
of  the  hip  and  shoulder,  the 
overlapping  is  greater  at  the 
opposite    side    than   at    the 
hip    or    shoulder    which    is 
being    covered.      The    spica 
bandages  (hip  and  shoulder) 
are  used  to  retain  dressings 
and  apparatus. 

The  double-headed  knot- 
ted bandage  is  made  of  a 
strip  of  muslin  about  eight 
yards  long  and  two  inches 
wide,   and  rolled    into    two 

heads  or  cylinders.  The  knotted  bandage  is  used  to  arrest 
haemorrhage  from  the  scalp  by  making  pressure  upon 
the  temporal  artery,  which  is  situated  just  in  front  of  the 
ear  and  extending  upward  into  the  scalp.  The  pulsa- 
tion of  this  vessel  can  easily  be  felt.  Before  applying  the 
bandage,  a  firm  compress  should  be  placed  over  the  artery 
at  a  level  with  the  upper  border  of  the  ear.     A  piece  of 


Fig.  41. 


-Ascending  spica  of  the 
shoulder. 


74 


PROMPT   AID   TO   THE   IXJURED. 


cork,  for  example,  about  half  an  inch  thick  and  the  diam- 
eter of  a  silver  half-dollar,  should  be  enveloped  in  a  piece 
of  soft  muslin  and  axoplied  over  the  artery.  The  operator 
then,  holding  a  roller  in  each  hand,  places  the  outside  of 
the  bandage  against  the  compress  and  carries  one  roller 
around  the  head  just  above  the  eyes  in  front,  and  the  other 
below  the  occipital  protuberance  or  "  bump  "  on  the  back 
of  the  head,  and  to  the  opposite  temple  ;  at  this  point  the 
hands  of  the  operator  change  rollers  and  return  them  to 
the  compress,  over  which  they  form  a  knot  by  twisting  and 
changing  theii'  dh^ection,  one  roller  being  carried  over  the 

top  of  the  head  and  the  other 
beneath  the  chin,  and  meet- 
ing at  the  opposite  side.  At 
this  point  the  rollers  are  again 
changed  and  returned  to  the 
compress,  over  which  a  second 
knot  or  twist  is  made  in  the 
same  manner  ;  two  or  three 
knots  over  the  compress  are 
usually  sufficient  to  arrest  the 
haemorrhage  (Fig.  42). 

There  are  a  number  of  band- 
ages which  can  not  be  classed 
with  either  the  roller  or  trian- 
gular bandage.     The  following  are  examples  : 

The  FOUR-TAILED  bajST)age  is  made  of  a  strip  of  muslin 
about  one  yard  and  a  half  long  and  four  inches  wide,  folded 
and  torn  from  the  ends  to  within  two  inches  of  the  center 
of  the  bandage.  One  jDair  of  tails  is  usually  made  broader 
than  the  other.  One  purpose  of  this  bandage  is  to  support 
the  lower  jaw  after  a  fracture  or  dislocation.  It  is  to  be 
applied  by  placing  the  center  of  the  bandage  against  the 
chin,  with  the  wide  tails  below,  when  the  latter  are  turned 
upward  and  tied  on  top  of  the  head ;  the  upper  or  narrow 
tails  are  carried  backward  and  tied  at  the  nape  of  the  neck 
(Fig.  43)  ;  two  handkerchiefs,  each  folded  in  the  form  of 


Fig.  42.— Knotted  bandage. 


BANDAGES,    DKKSSINGS,   ETC. 


75 


a  cravat,  may  be  used  for  this  purpose.    A  four- tailed  band- 
age, for  the  purpose  of  protection  and  retaining  dressings 

about  the  head,  can  be  made  of  a 

piece  of  muslin,  about  one  yard 

and  a  half  long  and  one  foot  or 

more  in  width,  folded,  and  torn. 

from  the  ends  to  within  six  inches 

of  the  center.      The  bandage  is 

placed  on  the  head,  the  anterior 

tails  being  carried  backward  and 

tied  at  the  nape  of  the  neck,  while 

the  posterior  tails  are  tied  under 

the  chin  (Fig.  44).    If  it  is  required 

that  the  bandage  should  be  applied 

to  the  back  of  the  head,  the  ante- 
rior or  upper  tails  are  tied  beneath 

the  chin,  while  the  posterior  or 

lower  tails  are  tied  upon  the  forehead. 

bandage  may  also  be  used  at  the  knee. 

made  of  a  strip  of  muslin 
about  eight  inches  wide  and 
one  yard  long,  and  applied  by 
placing  the  center  of  the  band- 
age over  the  patella ;  the  up- 
per tails  are  carried  backward, 
crossed  behind  the  knee,  then 
brought  forward  and  tied  in 
front  below  the  patella  ;  the 
lower  tails  are  manipulated  in 
a  similar  manner,  but  tied 
above  the  patella. 

The  entire  head  may  be 
covered  by  the  application  of  a 
six-tailed  bandage,  made  from 

a  piece  of  muslin  about  forty  inches  long  and  fifteen  inches 

wide  and  folded.     The  ends  should  be  torn  into  three  tails, 

extending  to  within  six  inches  of  the  center  of  the  band- 


Fig.  43. 

A  four-tailed 
It  should  be 


Fig.  44. 


76 


PROMPT   AID   TO   THE   INJURED. 


age  ;  the  middle  tail  should  be  made  wider  than  the  outer 
ones.  The  bandage  being  placed  on  the  head,  the  middle 
tails  are  tied  under  the  chin,  the  anterior  at  the  nape  of 
the  neck,  and  the  posterior  on  the  forehead. 

The  large  square  handkerchief -bandage  is  a  very  valu- 
able means  of  covering  the  head  and  neck,  and  is  applied 
by  folding  a  piece  of  muslm  about  one  yard  square,  in 
such  a  manner  that  the  upper  portion  or  layer  is  narrower 
than  the  lower  portion,  their  borders  being  two  or  three 
inches  apart.  The  bandage  is  so  placed  on  the  head  that 
the  border  of  the  upper  portion  is  on  a  level  with  the 
eyebrows,  while  the  lower  layer  rests  on  the  tip  of  the 
nose.  The  ends  of  the  upper  portion  are  tied  beneath  the 
chin  ;  the  border  of  the  lower  portion  is  then  turned  up- 


FiG.  45. 


ward  against  the  forehead,  thus  exposing  the  eyes,  while 
the  ends  of  this  portion  are  carried  backward  and  tied 
behind  the  neck  (Figs.  45  and  46). 

EsMARCH  OR  Triangular  Bandages  (see  diagram,  Fig. 


BANDAGES,   DRES.^INGS,   ETC. 


77 


47.) — The  triangular  baiidages,  whicli  have  been  brought  to 
the  notice  both  of  the  medical  profession  and  the  laity  by 
Prof.  Esmarch,  of 
Germany,  are  not  on- 
ly easily  made  from 
material  which  is  gen- 
erally procured  with- 
out difficulty,  but  are 
effective  as  a  dress- 
ing and  easily  applied, 
and  act  as  a  substitute 
for  the  roller  bandage 
in  all  cases  except 
where  uniform  press- 
ure is  the  essential 
element. 

If  a  choice  of 
material  is  permitted 
by  the  existing  cir- 
cumstances, the  un- 
bleached muslin  used  for  roller  bandages  should  be  se- 
lected ;  however,  a  large  handkerchief,  or  a  shirt  or  skirt, 
may  be  used. 


Fig.  46. 


Fig.  47.— Esmarch  bandage.    A,  base  ;  B,  apex  ;  C,  D,  basal  ends. 


It  will  be  unnecessary  to  enumerate  the  sizes  given  for 
the  different  triangular  bandages.     A  proper  knowledge 


78 


PROMPT   AID   TO  THE  INJURED. 


of  their  application  will  suflBciently  indicate  this  when 
being  used  on  different  portions  of  the  body. 

The  ends  of  a  triangular  bandage  should  be  fastened 
either  by  tymg  with  a  "  reef  "  or  flat  knot,  or  with  safety- 
pins  ;  the  knot,  however,  is  generally  used  (see  Knots). 

Head  (Figs.  48,  49,  and  52). — The  base  {A)  is  placed 
downward  over  the  brow,  with  the  apex  {B)  at  the  nape 


Fig.  48. 


Fio.  49. 


of  the  neck.  The  basal  ends  (C  and  D)  are  carried  back- 
ward above  the  ears  and  crossed  over  the  apex  below  the 
external  occipital  protuberance,  the  "  bump  "  on  the  back 
of  the  head  ;  this  prevents  the  bandage  from  slipping  up- 
ward ;  the  basal  ends  are  then  returned  to  the  front  and 
tied,  the  apex  being  turned  upward  and  pinned  to  the  body 
of  the  bandage. 

Shoulder  (Fig.  50). — The  triangle  should  be  applied  to 
the  shoulder  by  placing  the  base  {A)  downward  across  the 
middle  of  the  arm,  the  apex  {B)  being  turned  upward 
against  the  neck.  The  basal  ends  (C  and  D)  are  carried  to 
the  inner  side  of  the  arm,  crossed,  and  returned  to  the  out- 
side and  fastened.  The  apex  (B)  is  tied  or  pinned  to  a 
cravat  or  sling  placed  around  the  neck. 

Hand  (Fig.  50). — In  injury  to  the  posterior  part,  or 


BANDAGES,   DRESSINGS,   ETC. 


79 


dorsum,  the  hand  may  be  bandaged  by  placing"  the  base  of 
the  triangle  (A)  upward  at  the  back  part  of  the  wrist,  the 
hand  lying  on  the  bandage  ;  the  apex  (B)  is  turned  over 
the  fingers  upon  the  palm  and  carried  to  the  wrist ;  the 
basal  ends  (C  and  D)  are  then  carried  to  the  front  and 
crossed,  and  returned  to  the  back  of  the  wrist  and  tied,  or 
crossed  again,  and  tied  in  front.     In  injury  to  the  palmar 


Fig.  50. 

surface  of  the  hand,  the  base  should  be  first  applied  to  the 
front  of  the  wrist. 

Chest  (Figs.  51  and  52). — The  triangular  bandage  is 
applied  by  placing  the  base  (A)  downward  across  the  low- 
er border  of  the  chest,  with  the  apex  (B)  over  the  shoulder 
of  the  affected  side,  the  basal  ends  (C  and  D)  being  carried 
around  the  sides  to  the  back,  and  tied  together  in  such  a 
manner  that  one  end  of  the  knot  is  longer  than  the  other. 


80 


PROMPT    A.ID   TO   THE   INJURED. 


Fig.  51. 


The  long  end  is  then  tied  to  the  apex,  which  has  been  car- 
ried over  the  shoulder. 


Fig.  52. 


BANDAGES,   DRESSINGS,  ETC. 


81 


Slijigs.  —The 
ordinary  form  of 
an  arm  -  sling 
made  of  a  trian- 
gular bandage  is 
as  follows  (Fig. 
53) :  For  example, 
suppose  that  the 
left  arm  alone  is 
injured ;  the  base 
(A)  is  placed  ver- 
tically along  the 
outer  border  of 
the  right  side  of 
the  chest,  with  the 
basal  end  (C) 
thrown  over  the 
right  shoulder,  and  the  apex  (B) 
elbow,  the  left  arm  being  bent  at  a 
front  of  the  bandage.     The  basal 


Fig.  54. 


Fig.  53. 

placed  behind  the  left 
right  angle  and  held  in 
end  (D)  is  now  carried 
around  the  forearm 
and  over  the  left 
shoulder,  and  tied 
to  the  basal  end  (C) 
at  the  back  of  the 
neck.  The  apex  (B) 
is  then  carried 
around  the  elbow 
and  pinned  to  the 
bandage  in  front. 

Should  it  hap- 
pen that  the  left 
shoulder  or  clavicu- 
lar (collar-bone)  re- 
gion is  injured  as 
well  as  the  arm, 
the  sling  should  be 


82 


PROMPT   AID   TO   THE   INJUPiED. 


so  arranged  that  the  affected  part  is  free  from  pressure, 
which  may  be  accomplished  in  the  following  way  (Fig. 
54) :  The  bandage  is  to  be  applied  in  a  manner  similar  to 
the  one  just  described,  with  this  exception — instead  of  the 
basal  end  {D)  being  carried  over  the  left  shoulder,  it  is  car- 
ried under  the  left  arm,  then  upward  across  the  back,  and 
tied  to  the  basal  end  (O)  over  the  right  shoulder. 

If  the  right  shoulder  or  clavicular  region  be  injured 
as  well  as  the  left  arm,  the  latter  can  be  placed  in  a  sling, 
leaving  the  affected  shoulder  (the  right)  uncovered  by  lay- 
ing the  basal  end  (C)  over  the  left  shoulder,  the  base  {A) 
being  carried  from  above  obliquely  downward  and  to  the 

right,  the  apex  of 
the  bandage  and 
the  arm  being  in 
the  same  position 
as  in  the  slings  just 
enumerated.  The 
basal  end  (D)  is 
now  carried  under 
the  left  arm  and 
upward  over  the 
back,  and  tied  to 
the  basal  end  (C) 
at  the  left  shoulder 
(Fig.  55). 

Hip.  —  The  tri- 
angular bandage 
at  this  portion  of 
the  body  is  applied 
in  very  much  the  same  way  as  at  the  shoulder.  The  cen- 
ter of  the  base  (A)  is  placed  downward  across  the  middle 
of  the  thigh,  the  ai^ex  (B)  being  carried  upward  above  the 
crest  or  upper  border  of  the  pelvis  or  haunch-bone,  the 
basal  ends  (C  and  D)  are  carried  around  the  thigh,  and 
fastened  at  the  outside.  The  apex  (E)  is  attached  above 
to  a  cravat  around  the  waist  (Fig.  56). 


Fig.  55. 


BANDAGES,   DRESSINGS,   ETC. 


83 


Fig.  56. 


Foot. — The  foot  should  be  placed  on  the  triangle  with 
the  base  {A)  backward,  and  laid  behind  the  ankle,  the  apex 
being  carried  upward  over 
the  dorsum  or  top  of  the  foot. 
The  basal  ends  (C  and  D)  are 
brought  forward,  crossed, 
then  carried  around  the  foot, 
and  tied  on  top  (Fig.  57). 

Cravat-Bandages  (Figs. 
50,  58,  59). — A  triangular 
bandage  folded  in  the  form 
of  a  cravat  makes  a  very 
effective  means  of  arresting 
hemorrhage  and  retaining 
splints,  dressings,  and  poul- 
tices. The  width  of  the  cra- 
vat, or  the  number  of  folds,  dei^ends  upon  the  use  for  which 


Fig.  57. 


84 


PROMPT    AID   TO   THE   INJURED. 


it  is  applied.  The  center  of  the  cravat  should  be  laid  against 
the  affected  part,  or  on  the  poultice,  or  whatever  the  cravat 
is  used  to  retain,  the  ends  of  the  cravat  being  carried  around 


Fig.  58. 


Fig.  59. 


the  limb  and  tied  over  the  center  of  the  base.  When  used 
to  retain  splints,  they  should  be  tied  on  the  outer  side  of  the 
limb  and  against  the  splint,  thus  preventing  the  knot  from 
irritating  the  skin.  Cravats  are  used  to  retain  di'essings 
about  the  head,  eyes,  ears,  neck,  etc.  When  used  to  re- 
tain a  di'essing  in  the  arm-pit,  the  center  of  the  cravat 
should  be  placed  under  the  arm,  and  the  ends  carried  up- 
ward and  crossed  over  the  shoulder,  and  tied  in  the  ax- 
illary space  of  the  opposite  side,  thus  forming  a  figure  of 
8.  In  retaining  dressing  about  the  groin  and  in  that  vicin- 
ity, the  middle  of  the  bandage  is  placed  at  the  inner  and 
upper  part  of  the  thigh  (the  "  crotch  "),  the  extremities  be- 
ing carried  upward  and  outward  and  crossed  at  the  hip,  the 
ends  being  brought  over  to  the  hip  at  the  opposite  side  and 
tied. 


BANDAGES,   DRESSINGS,   ETC. 


85 


The  cravat  may  also  be  used  as  a 
sling  for  the  arm  where  simply  sup- 
port, but  not  protection,  is  necessaiy. 

Knots. — Tlio  ends  of  a  triangular 
and  cravat-bandage  are  fastened  by 
tying  with  a  ''reef"  or  square  or 
flat  knot  (Figs.    60  and   61).      This 


Fig.  60.— Reef  knot. 


Fig.  61.— Reef  knot. 


knot  is  very  secure,  and  does  not  slip ;  it  is  used  by  sur- 
geons in  ligating  vessels.  However,  unless  care  is  ob- 
served, a  "  granny "  knot  (Figs.  62  and  63),  which  is 
quite  insecure,  is  often  substituted.     The  reef  knot  is  made 

by  holding  an  extremity  of 
the  bandage  in  each  hand, 
and  then  passing  the  end  in 
the  right  hand  over  the  one 
in.  the  left  and  tying  ;  the 
end  now  in  the  left  hand  is 
passed  over  the  one  in  the 


Fig.  62.— Granny  knot. 


Fig.  63.— Granny  knot. 


86 


PROMPT   AID   TO   THE   IXJURED. 


right  and  again  tied.     In  the  '"  granny ''  knot  the  end  in 

the  right  hand  is  car- 
ried over  that  in  the 
left  both  times  and 
tied  (Fig.  63). 

A  surgeon's  knot  is 
used  in  ligating  blood- 
vessels, and  is  made  by 

Fig.  64  —Surgeon's  knot.  turning   the    ends    of    a 

ligature  twice  around 
each  other  before  tying  (Fig.  64),  and  then  securing  it  as 
in  the  reef  knot. 


COMPRESSES. 

Compresses  or  pads,  as  generally  used,  are  of  two  kinds 
— simple  and  graduated. 

A  simple  compress  consists  of  a  number  of  even  folds 
of  muslin,  or  other  similar  material,  applied  to  a  part  to 
assist  in  arresting  haemorrhage  (by  pressure),  to  hold  the 
edges  of  a  wound  together,  and  also  for  protection.  A 
graduated  compress  is  made  by  diminishing  the  width  of 
each  successive  layer  until  the  compress  has  been  made 
pyramidal  or  pointed,  and  having  a  base  and  an  apex. 
When  applied,  the  graduated  compress  is  inverted,  the 
apex  being  placed  first  in  the  wound.  This  form  of  com- 
press is  used  to  arrest  haemorrhage  from  deep  wounds  and 
cavities. 

Compresses  are  made  of  antiseptic  or  sterilized  gauze, 
lint,  muslin,  linen,  flannel,  etc..  the  antiseptic  or  sterilized 
gauze  being  the  most  desirable.  If  this  can  not  be  pro- 
cured, the  material  selected  should  be  clean,  and,  if  pos- 
sible, made  aseptic  by  boiling  for  at  least  half  an  hour. 
Lint  is  objected  to,  as  the  surfaces — particularly  one  of 
them — is  downy,  and  adheres  to  the  wound.  The  com- 
mon picked  lint  is  objectionable  for  the  same  reason. 
A  compress  made  of  a  fabric  such  as  gauze,  which  admits 


BANDAGES,   DRESSINGS,   ETC.  87 

of  absorption  of  tlie  fluids  from  a  wound,  is  more  valuable 
than  one  which  resists  it. 

A  compress  should  not  be  allowed  to  remain  applied 
after  it  has  become  ofPensive  or  soaked  with  discharges. 

TAMPON. 

A  tampon  or  plug  is  made  of  the  same  material  used 
for  compresses,  and,  in  addition,  absorbent  cotton,  lamp- 
wicking,  common  muslin  bandages,  etc.,  are  often  utilized. 
A  tampon  has  no  special  size  or  shape,  but  is  formed  in 
such  a  manner  that  it  can  be  pressed  deeply  into  a  wound 
in  order  to  arrest  haemorrhage,  for  which  it  is  principally 
employed.  It  is  of  the  utmost  importance  that  a  tampon 
should  be  clean,  in  order  to  prevent,  if  possible,  the  en- 
trance of  poisonous  germs.  It  should  be  remembered 
that,  although  it  is  necessary  in  order  to  arrest  haem- 
orrhage by  tamponing  that  the  wound  should  be  thor- 
oughly filled  from  the  bottom,  too  forcible  manipulation 
may  be  followed  by  serious  consequences,  and  that  even 
the  proper,  application  of  a  plug  usually  prevents  union 
by  first  intention.  A  tampon  as  well  as  a  compress  is 
kept  firmly  in  place  by  a  bandage,  which  exerts  more  or 
less  pressure  as  the  case  requires.  Without  the  indorse- 
ment of  a  surgeon,  a  tampon  should  not  be  left  in  a  wound 
longer  than  twelve  hours. 

POULTICES. 

Poultices  are  used  to  supply  and  retain  heat  and  mois- 
ture, and  thereby  relieve  internal  congestion  and  pain ; 
they  are  sometimes  employed  to  hasten  the  removal  of  a 
slough  or  dead  tissue,  and  to  clean  the  surface  of  foul 
ulcers. 

However,  as  they  favor  the  development  of  bacteria 
(germs)  when  applied  to  an  open  wound,  surgeons  do  not 
now  use  them  for  this  form  of  injury.  Therefore  their 
employment  for  the  purpose  of  facilitating  the  removal  of 


88  PROMPT  AID   TO   THE   INJURED. 

a  "  slough  "  or  dead  tissue  is  only  justified  when  other 
means  are  not  available.  A  much  better  way  of  secur- 
ing this  result  is  by  the  use  of  compresses  wrung  out  in  a 
hot  solution  of  bichloride  of  mercury  (1-10,000),  or  a  solu- 
tion of  carbolic  acid  (one  per  cent.),  and  applied  directly 
to  the  slough  and  covered  with  oiled  silk  to  retain  the 
heat.  This  di'essing  should  be  renewed  every  two  or  three 
hours. 

Poultices  are  usually  made  of  ground  flaxseed  (linseed), 
although,  if  this  can  not  be  procured,  hominy,  corn-meal, 
or  bread  (not  the  crust),  may  be  substituted.  A  bread- 
poultice,  however,  becomes  sour  in  a  very  short  time. 

Flaxseed-Poultice. — A  receptacle  containing  boiling 
water  should  be  placed  on  the  fire.  The  flaxseed-meal 
should  then  be  gradually  added,  and  constantly  stirred, 
until  the  batter  is  jelly-like,  and  about  the  consistence  of 
oatmeal  porridge.  This  should  be  evenly  spread,  with  a 
thickness  of  about  half  an  inch,  on  a  folded  towel,  piece 
of  muslin,  or  some  other  material  prepared  for  the  purpose  ; 
over  the  surface  of  the  flaxseed  should  be  laid  some  white 
tarlatan,  mosquito-netting,  or  a  fine  cambric  hahd kerchief ; 
while  these  fabrics  allow  the  poultice  to  come  in  direct 
contact  with  the  skin — an  important  consideration — they 
do  not  interfere  with  its  action,  but  prevent  the  flaxseed 
from  adhering  to  the  skin.  If  one  of  the  above  materials 
can  not  be  obtained,  the  surface  of  the  poultice  may  be 
covered  with  a  small  amount  of  vaseline  or  sweet-oil  as 
a  substitute.  After  the  poultice  is  applied  to  the  body  it 
should  be  covered,  if  possible,  with  oiled  silk,  which  aids 
in  retaining  the  heat ;  in  this  way  a  poultice  can  be  kept 
warm  and  moist  for  two  or  three  hours,  or  even  longer. 
In  lieu  of  the  oiled  silk,  flannel  or  cotton  wadding  may 
be  used. 

To  a  certain  extent  a  poultice  can  be  made  a  deodorant 
by  adding  to  the  boiling  water  into  which  the  meal  is 
thrown  a  teaspoonful  of  carbolic  acid  to  each  pint  of  water, 
or  by  adding  to  the  dry  meal,  before  it  is  thrown  into  the 


BANDAGES,   DRESSIN(iS,   ETC.  89 

water;  one  half  of  its  bulk  of  powdered  charcoal.  This 
mixture  should  be  thoroughly  rubbed  together,  and  then 
added  to  the  water  in  the  manner  already  described.  The 
addition  of  the  carbolic  acid  makes  the  poultice  more  or 
less  antiseptic. 

Poultices  made  of  bread,  corn-meal,  or  hominy  have 
nothing  in  their  favor  when  compared  with  flaxseed,  save 
that  they  may  be  the  only  available  substances  when 
needed.  Poultices  of  these  materials  are  made  in  the 
same  manner  as  when  flaxseed  is  used.  A  teaspoonful  of 
salt  should  be  added  to  each  application,  particularly 
when  corn-meal  or  hominy  is  used,  otherwise  considerable 
irritation  of  the  skin  (covered  by  the  poultice)  may  ensue. 

The  addition  of  mustard  to  a  poultice  renders  it  more 
effective  in  diminishing  or  relieving  deep-seated  pain,  as 
in  the  chest  or  abdomen,  and  is  far  better,  for  ordinary 
purposes,  than  mustard-plasters,  which  are  too  indiscrimi- 
nately used.  Mustai'd,  properly  applied  in  this  manner,  is 
seldom  followed  by  undue  irritation  of  the  skin.  The  mus- 
tard should  not  be  added  to  the  flaxseed  in  the  form  of 
powder,  but  should  be  carefully  mixed  w4tli  a  small 
amount  of  warm  water,  and  then  stirred  into  the  flaxseed 
just  before  it  is  spread  upon  the  cloth.  The  amount  of 
mustard  added  depends  upon  the  degree  of  pain,  the  age 
of  the  patient,  etc. ;  the  proportion  ranges  from  a  table- 
spoonful  to  one  third,  or  even  one  half,  of  the  bulk  of  the 
poultice,  one  or  two  tablespoonfuls,  however,  being  usu- 
ally sufficient.  Hot  water  and  vinegar  lessen  the  efficacy 
of  mustard. 

Mustard-plasters  are  used  to  obtain  a  rapid  and  decided 
effect,  as  in  shock,  poisoning,  etc.  Care  should  be  taken, 
however,  that  the  mustard  does  not  blister  the  skin. 

As  a  rule,  mustard-plasters  should  not  be  applied  to 
children  and  old  people,  as  they  generally  blister  the  sur- 
face, and,  if  the  plaster  is  quite  large,  ^veil-marked  con- 
stitutional symptoms  may  follow,  as  elevation  of  temper- 
ature. 


90  PROMPT   AID   TO   THE   INJURED. 

In  making  a  mustard-plaster,  it  is  preferable  to  mix 
the  powder  with  the  white  of  an  egg,  although  water  may 
be  substituted ;  a  small  amount  of  flour  may  be  added,  and 
the  paste  should  then  be  thinly  spread  over  a  piece  of  mus- 
lin or  brown  paper,  and  covered  with  some  thin  material. 

MOIST  AND   DRY  HEAT. 

Moist  Heat. — A  hot  fomentation  consists  in  the  ap- 
plication of  moist  heat,  and  is  used  to  relieve  pain,  pro- 
duce relaxation,  etc.,  and  in  a  manner  acts  as  a  substi- 
tute for  a  poultice.  A  hot  fomentation  is  made  by 
wringing  out  of  hot  water  a  piece  of  flannel,  old  blan- 
ket, etc.,  which  is  applied  immediately  to  the  affected  part 
and  properly  protected,  to  prevent  evaporation  and  the 
consequent  cooling  of  the  dressing.  For  the  latter  rea- 
son a  hot  fomentation  is  not  used  when  heat  alone  is 
desired.  By  stirring  in  the  hot  water  from  one  to  three 
tablespoonfuls  of  spirits  of  turpentine,  the  stimulant  and 
anodyne  or  quieting  effects  of  the  fomentation  are  in- 
creased. A  hot  fomentation  applied  to  the  forehead  and 
temple,  when  headache  exists,  is  often  followed  by  imme- 
diate relief. 

Dry  Heat. — Dry  heat  is  employed  when  the  applica- 
tion and  retention  of  heat  are  the  essential  elements,  as 
in  shock,  syncope,  drowning,  etc.  Dry  heat  is  used  in  the 
form  of  bottles  or  India-rubber  bags  filled  with  hot  water, 
or  bran,  salt,  or  sand,  which  has  been  heated  in  the  oven 
and  put  in  bags.  Bran  is  to  be  preferred,  as  it  retains 
heat  longer,  and  is  very  light.  Hot  bricks,  stones,  flat- 
irons,  stove-lids,  plates,  etc.,  may  also  be  used;  the  latter 
agents  should  be  covered  with  a  towel  or  some  similar 
substance  before  being  applied. 

In  shock  and  some  other  conditions  the  sensation  is  so 
blunted  that  the  skin  may  be  burned  by  one  of  the  appli- 
ances just  enumerated  (except  the  bran,  salt,  and  sand] 
without  being  appreciated  by  the  patient. 


CHAPTER    IX. 

CONTUSIONS  AND    WOUNDS, 
CONTUSIONS— BRUISES. 

A  CONTUSION  is  an  injury  inflicted  upon  a  portion  of 
the  body  by  a  blow  from  a  blunt  instrument,  also  from  a 
fall,  or  severe  pressure,  and  resulting  in  the  laceration  of 
blood-vessels  (usually  small)  and  other  structures  beneath 
the  skin,  the  latter  remaining  unbroken. 

The  subcutaneous  escape  of  blood  is  immediately  fol- 
lowed by  swelling  and  discoloration  of  the  skin  ;  the  color 
being  at  first  black  and  blue  or  purplish,  then  green,  yellow, 
and  so  on  until  the  extravasated  blood  is  removed  by  ab- 
sorption, and  the  affected  part  regains  its  normal  color  and 
appearance — usually  within  two  weeks.  A  ".black  eye  "  is 
a  familiar  examj)le  of  a  simple  contusion. 

In  severe  contusions,  although  the  skin  may  be  at  first 
unbroken,  the  soft  tissues  are  often  so  badly  injured  that 
death  (gangrene)  of  the  affected  structures  follows. 

In  contusions  which  extend  deeply  into  the  tissues,  the 
discoloration  may  not  appear  for  a  number  of  days. 

When  a  contusion  is  followed  by  very  rapid  and  ex- 
tensive swelling,  in  which  pulsation  can  be  detected,  it 
indicates  that  a  large  artery  has  been  divided. 

Treatment. — Slight  contusions  need  no  special  consid- 
eration. In  those  of  a  severer  nature  the  treatment  depends 
upon  the  time  that  has  elapsed  since  the  injury,  and  its 
gravity.     If  seen  early,  the  indications  for  treatment  are — 

(1)  to  prevent  the  further  escape  of  blood  in  the  tissues  ; 

(2)  to  counteract  the  pain,  shock,  or  inflammatory  action 


92  PROMPT   AID  TO   THE   INJURED. 

that  may  follow  ;  (3)  to  preserve  the  vitality  of  the  part, 
which  may  be  endangered  in  severe  contusions ;  (4)  to  pro- 
mote the  absorption  of  the  blood  which  has  already  es- 
caped. The  first  indication  can  be  met  by  the  use  of  hot 
(not  warm)  or  cold  applications,  the  latter  usually  prov- 
ing more  effective — particularly  if  used  in  the  form  of  ice 
broken  into  small  pieces  and  placed  in  a  rubber  bag  made 
for  this  purpose,  or  in  a  bladder  or  towel,  and  applied  to 
the  part  and  retained  07ily  until  the  haemorrhage  is  con- 
trolled. Although  ice  is  a  valuable  agent  to  check  the 
extravasation  of  blood,  it  should  be  used  with  care,  and 
not  in  all  cases.  In  slight  contusions  it  is  particularly 
valuable  and  unattended  with  danger ;  in  a  severe  form  of 
contusion,  however,  where  the  vitality  of  the  affected  tis- 
sues is  impaired,  the  use  of  ice,  by  still  further  reducing  the 
vitality,  may  cause  gangrene  of  the  parts.  Compresses 
soaked  in  dilute  alcoholic  solutions  of  whisky,  brandy, 
cologne,  arnica,  camphor,  etc.,  or,  solutions  containing  ace- 
tate of  lead  (sugar  of  lead),  carbolic  acid,  alum,  vinegar, 
lemon- juice,  or  common  salt,  are  also  very  efficacious. 
Pressure  carefully  employed,  in  addition  to  the  applica- 
tions just  referred  to,  will  render  the  treatment  still  more 
effective.  Elevation  of  the  affected  part  diminishes  the 
tendency  to  further  extravasation  of  blood.  If  shock  ac- 
companies the  contusion,  it  is  to  be  treated  according  to 
the  directions  given  in  another  chapter. 

The  pain  that  is  commonly  present  in  a  contusion  is 
usually  quieted  by  the  applications  used  to  fulfill  the  first 
indication.  The  tendency  to  subsequent  inflammation  is 
treated  by  judicious  use  of  cold,  rest,  elevation,  etc. 

In  severe  contusions,  where  the  vitality  of  the  part  is 
greatly  impaired  by  the  obstruction  to  the  circulation  due 
to  the  escape  of  blood  into  the  tissues  and  consequent 
swelling,  the  temperature  of  the  part  is  lowered,  and  cold 
should  not  be  used.  The  local  application  of  warmth  is 
then  indicated  ;  and  should  be  applied  in  a  dry  form,  as 
bottles  filled  with  hot  w^ater;   a  bag  filled  with  bran  or 


CONTUSIONS  AND   WOUNDS.  93 

oatmeal  which  has  beeD  heated  in  the  oven,  or  whatever 
form  of  dry  heat  can  he  easily  and  quickly  obtained,  will 
answer.  Tlie  part  should  also  be  surrounded  by  woolen 
cloths  or  any  fabric  that  will  retain  the  heat,  and  if  a  limb 
is  the  part  a£Pected,  it  should  be  slightly  elevated. 

The  local  treatment  for  a  contusion  which  has  existed 
for  some  time,  consists  in  stimulating  the  absorption  of  the 
extravasated  blood,  and  may  be  accomplished  by  continu- 
ous mild  pressure,  gentle  friction  alone  or  combined  with 
the  stimulating  solutions  already  mentioned,  which  are 
useful  for  this  purpose. 

WOUNDS. 

A  wound  is  an  injury  of  the  outer  tissues  in  any  part 
of  the  body,  associated  with  more  or  less  division  of  the 
skin  and  deeper  soft  structures,  and  produced  by  a  mechan- 
ical agent. 

Wounds  are  classified  as  follows  :  Incised,  lacerated, 
punctured,  gunshot,  poisoned,  and  contused. 

Incised  wounds  are  made  by  sharp  cutting  instru- 
ments, as  knives  or  razors.  The  edges  of  the  wound, 
when  applied  to  each  other,  fit  accurately,  and  completely 
close  the  opening.  Haemorrhage  constitutes  one  of  the 
principal  dangers  of  this  form  of  injury. 

Lacerated  wounds  are  made  by  stones,  clubs,  or  imple- 
ments which  are  rough  or  blunt,  and  produce  more  or  less 
destruction  of  tissue  about  the  wound,  the  edges  of  which 
are  ragged  and  torn.  Considerable  local  inflammation  and 
constitutional  disturbance  often  follow  lacerated  wounds. 

Punctured  wounds  are  inflicted  by  bayonets,  daggers, 
swords,  arrows,  or  other  weapons  which  are  sharp  and 
narrow-pointed.  Although  the  openings  are  quite  small, 
these  wounds  usually  penetrate  to  a  considerable  depth, 
and  may  injure  important  blood-vessels  and  vital  organs. 

Gunshot  wounds,  in  a  general  way,  include  all  injuries 
resulting  from  the  explosion  of  gunpowder,  the  direct 
cause  being  bullets,  cannon-balls,  and  other  missiles  ;  also 


9i  PROMPT  AID   TO   THE   INJURED. 

splinters  of  wood,  pieces  of  stone,  etc.  The  degree  of  dan- 
ger resulting  from  gunshot  wounds  depends  upon  the 
hsemorrhage — particularly  that  occurring  internally — the 
sti'ucture  or  organ  involved,  the  amount  of  tissue  destroyed, 
together  with  the  shock,  and  the  subsequent  inflammation 
and  suppuration,  and  blood-poisoning  which  may  result. 

The  conical  ball  used  at  the  present  day  is  more  danger- 
ous than  the  round  one.  The  latter  is  quite  commonly  de- 
flected or  turned  aside  from  its  original  course  by  bony 
prominences,  fasciae,  or  tendons,  and  thus  often  i)revents  in- 
jury to  internal  organs,  and  when  imbedded  in  the  deeper 
structures  is  more  apt  to  become  encysted — that  is,  the 
ball  is  provided,  by  the  tissues  adjacent  to  it,  with  a  cover- 
ing or  capsule,  which  prevents  the  missDe  from  irritat- 
ing the  contiguous  structures.  Thus  protected,  the  ball 
may  remain  indefinitely  without  causing  harm. 

Foreign  substances,  such  as  bits  of  clothing,  are  often 
carried  into  the  body  by  bullets  and  other  missiles  (fre- 
quently beyond  observation),  and  constitute  an  additional 
element  of  danger.  The  point  of  entrance  of  a  ball  is  apt 
to  be  smaller  than  the  exit,  as  the  result,  of  the  diminished 
velocity. 

Poisoned  wounds  are  caused  by  the  introduction  into 
the  tissue,  through  the  skin,  of  some  form  of  virus,  as 
in  a  snake-bite.  These  wounds  are  usually  punctured, 
although  they  may  be  lacerated,  as  in  the  bite  of  a  rabid 
dog. 

Contrary  to  the  general  belief,  the  bite  of  the  venomous 
snakes  in  this  country,  such  as  the  rattlesnake,  moccasin, 
copperhead,  and  one  or  two  others,  is  not  generally  fatal, 
and,  although  the  virus  acts  with  great  rapidity  and  in- 
tensity, only  about  one  out  of  every  seven  or  eight  bit- 
ten succumb  to  it.  Snakes  are  most  dangerous  in  warm 
weather  and  after  fasting.  A  person  who  has  been  bitten 
by  a  poisonous  serpent  becomes  faint  and  greatly  depressed 
within  a  few  minutes,  the  pulse  feeble,  and  the  pupils  di- 
lated :  more  or  less  delirium  occurs,  and  the  extremities 


CONTUSIONS   AND   WOUNDS.  05 

become-cold  and  clammy.  Considerable  swelling  and  dis- 
coloration usually  take  place  about  the  wound  ;  intense 
pain  is  also  present.  In  a  certain  proportion  of  cases 
death  ensues  within  a  few  hours. 

A  contused  wound  is  one  in  which  the  division  of  the 
soft  structures  is  associated  with  more  or  less  contusion  at 
the  site  of  injury. 

Healing  of  Wounds.  —  Although  the  healing  of 
wounds  is  divided  by  surgeons  into  a  number  of  different 
varieties,  it  will  be  sufficient  in  this  description  to  recog- 
nize but  two  of  them — union  by  first  intention;  and 
granulation,  or  union  by  second  intention. 

Union  by  first  intention  usually  occurs  when  the  edges 
of  the  wound  fit  accurately,  and  are  not  displaced  by 
haemorrhage  or  improper  dressing  ;  when  foreign  bodies 
are  removed  and  the  wound  properly  cleaned,  and  the 
injured  part  kept  quiet.  It  is  always  desirable,  if  pos- 
sible, to  obtain  this  result,  which,  besides  other  advan- 
tages, prevents  disfiguring  scars. 

Wounds  associated  with  considerable  destruction  of 
tissue,  as  in  lacerated  wounds,  burns  of  the  third  degree, 
etc.,  heal  by  granulation.  The  first  step  in  this  form  of 
repair  is  the  removal  by  nature  of  the  destroyed  and  use- 
less tissue  about  the  wound  by  the  processes  known  as 
suppuration  or  ''  maturation,"  and  sloughing.  After  the 
wound  has  been  thus  cleaned,  granulation  becomes  ap- 
parent ;  little  conical  shoots  about  the  size  of  a  pin-head, 
and  pinkish  in  color,  are  found  filling  up  the  cavity  of 
the  wound.  These  little  bodies  are  very  vascular,  and 
when  excessive  in  size,  and  too  rapid  in  growth,  they  rise 
above  the  surrounding  part,  and  are  commonly  known  as 
"proud  flesh."  After  granulation  has  entirely  filled  the 
wound,  the  upper  surface  becomes  smooth,  shining,  and 
red,  which  appearance  is  the  result  of  the  process  of  cica- 
trization, and  is  known  as  a  "scar"  or  cicatrix.  The 
scar  gradually  becomes  even  whiter  than  the  normal 
skin,    and    undergoes    more    or    less    contraction.      The 


96  TROMPT   AID   TO   THE   INJURED. 

g-lands  of  the  destroyed  skin  are  not  reproduced  in  tlie 
scar,  consequently  hair  does  not  grow  from  the  new  for- 
mation. 

The  proper  healing  of  wounds  is  often  interfered  with 
by  severe  local  inflammation  and  constitutional  disturb- 
ances. Surgeons  believe  such  phenomena  to  be  due  to 
the  existence  of  microscopical  particles  in  the  air,  called 
"  micro-organisms,"  or  bacteria,  which  infect  fresh  wounds. 
The  theory  has  developed  within  recent  years  a  method 
known  as  the  antiseptic  treatment,  which  means  the  em- 
ployment, about  the  ^vound,  of  agents  which  destroy  or 
retard  the  growth  of  the  micro-organisms.  The  success  of 
this  treatment  depends  not  only  on  the  application  of  anti- 
septics to  the  wound,  but  on  rejidering  aseptic  everything 
that  comes  in  contact  with  it,  even  the  hands  of  the  at- 
tendant, the  dressings,  and  instruments.  Surgeons  now 
use  aseptic  sutures  (stitches)  of  different  substances,  most 
commonly  those  made  of  catgut,  which  are  absorbed  in 
the  wound — their  removal  being  unnecessary — a  very  im- 
portant consideration.  If  drainage  is  essential,  aseptic 
tubes  are  introduced  into  the  wound  to  favor  the  free  exit 
of  discharges.  The  wound  is  then  covered  with  aseptic  oi! 
antiseptic  gauze,  secured  by  bandages,  and  left  undisturbed 
until  healing  has  taken  place  (about  three  days),  j)rovided 
the  dressings  do  not  become  soiled  or  offensive.  It  is  not 
expected  that  members  of  the  ambulance  corps,  or  othei 
non-medical  persons,  will  be  able  to  comply  with  the  de- 
tails just  given,  but  the  principle  should  be  remembered 
and  followed  as  nearly  as  the  circumstances  will  permit. 
.  Treatment  of  Wounds. — The  treatment  of  a  wound 
consists  of  the  following  indications :  arrest  of  haemor- 
rhage ;  examination  of  the  wound,  and  removal  of  all  for- 
eign matter  therefrom ;  support  and  protection  of  the  in- 
jured part ;  and  rest. 

The  variety  of  hemorrhage  should  be  determined, 
whether  arterial,  venous,  or  capillary,  and  arrested  in  the 
manner  described  in  the  chapter  devoted  to  that  subject. 


CONTUSIONS  AND    WOUNDS.  97 

A  , wound  should  be  examined  as  to  its  variety — 
whether  incised,  lacerated,  etc. — and  also  as  to  the 
structures  involved.  A  careful  search  should  be  made  for 
foreign  bodies,  which,  if  allowed  to  remain,  would  inter- 
fere with  the  proper  healing  of  the  part.  Pieces  of  cloth- 
ing, splinters,  etc.,  should  be  picked  out  with  clean  fin- 
gers, and  the  wound  then  cleaned  with  a  disinfecting  so- 
lution (see  Disinfectants).  If  this  is  not  available,  pure 
water,  or,  still  better,  water  which  has  been  boiled  (thus 
destroying  the  germs  it  contains),  may  be  used. 

Further  treatment  in  the  absence  of  the  surgeon  de- 
pends upon  the  character  of  the  wound.  If  incised,  the 
edges  should  be  brought  closely  and  accurately  together 
and  retained  in  apposition,  by  applying  over  the  opening 
a  compress  made  of  antiseptic  gauze,  preferably,  and  then 
holding  the  parts  together  by  strips  of  adhesive  plaster. 
This  is  a  substitute  for  the  proper  closing  of  the  wound 
by  the  use  of  sutures  or  stitches,  which  hold  the  edges 
closely  together  and  favor  accurate  union.  The  strips  of 
adhesive  plaster  should  not  entirely  surround  a  limb,  as 
they  would  then  interfere  with  the  circulation.  They 
should  be  applied  with  intervals  between  them,  to  allow 
the  free  exit  of  any  matter  or  pus  which  may  form  at  the 
site  of  the  injury;  one  end  of  the  strip  being  placed  on 
one  side  of  the  wound,  the  edges  of  which  are  held  closely 
together,  the  remainder  of  the  strip  is  carried  over  the 
wound  and  fastened  to  the  opposite  side.  In  removing 
adhesive  plaster,  both  ends  of  the  strip  should  be  loosened 
at  the  same  time  and  carried  from  the  skin  toward  the 
wound,  thereby  preventing  the  separation  of  its  edges, 
and  thus  interfering  with  the  healing  process. 

Great  care  should  be  taken  that  the  compresses  which 
support  and  protect  the  wound  are  made  of  some  clean, 
soft  material,  such  as  linen,  muslin,  lint,  flannel,  absorb- 
ent cotton,  oakum,  or,  best  of  all,  antiseptic  gauze,  which 
can  now  be  purchased  in  any  drug-store. 

The  compress  should  be  held  in  place  by  a  bandage, 
8 


98  PROMPT  AID  TO  THE  INJURED. 

which  also  helps  to  keep  the  edges  of  the  wound  together 
and  prevents  hsemorrhage  (see  Baxdages).  The  dressing 
should  remain  undisturbed  until  healing  takes  place,  un- 
less it  becomes  offensive,  or  severe  local  pains,  chills  and 
fever  occur. 

Lacerated  wounds,  which  are  associated  with  more  or 
less  destruction  and  loss  of  tissue,  heal  by  granulation; 
consequently  no  effort  need  be  made  to  bring  the  edges 
in  direct  apposition,  which  might  subsequently  interfere 
with  the  proper  escape  of  discharges;  otherwise  the  same 
kind  of  dressing  should  be  applied  as  in  incised  wounds. 
Lacerated  wounds  should  be  cleansed  and  fresh  dressings 
applied  whenever  indicated  by  the  presence  of  an  offensive 
odor,  or  a  soiled  condition  of  the  compress  and  bandages. 
Owing  to  the  very  vascular  condition  of  the  face  and 
scalp,  lacerated  wounds  of  these  parts,  if  not  too  severe, 
often  heal  by  primary  union,  and  may  be  treated  as  in- 
cised wounds  until  some  evidence  of  suppuration  or 
sloughing  appears. 

The  immediate  local  treatment  of  a  punctured  wound 
is  very  simple,  and  consists  in  applying  a  soothing  anti- 
septic lotion.  The  result  of  such  a  wound  is  extremely 
uncertain,  and  depends  upon  the  implement  causing  the 
injury,  and  should  be  carefully  watched  for  any  evidence 
of  subsequent  inflammation.  Punctured  wounds  made  by 
arrows  are  generally  serious,  because  the  arrow-head  usu- 
ally remains  in  the  tissues.  In  this  case  the  arrow  should, 
if  possible,  be  withdrawn  by  a  rotary  movement,  or,  if 
near  the  surface,  it  can  be  pushed  out  through  sound  tis- 
sue, its  exit  being  accelerated  by  making  a  small  cut  or 
incision  over  the  arrow-point.  Ji  the  shaft  has  been 
broken  off,  and  the  arrow-head  remains  in  the  tissues, 
it  will  be  necessary  for  the  surgeon  to  cut  down  and  ex- 
tract it. 

In  gunshot  wounds  the  first  effort  should  be  to  arrest 
haemorrhage,  to  protect  the  wound  with  dressings,  and 
treat  the  accompanying  shock.    However,  all  foreign  bod- 


CONTUSIONS  AND  WOUNDS.  99 

ies  which  are  about  the  surface  of  the  wound  and  are 
not  retained  by  blood-clots  can  be  removed.  No  explora- 
tion for  the  bullet  should  be  made  except  by  a  surgeon. 
The  wound  should,  if  possible,  be  dressed  antiseptically 
and  splints  applied  to  prevent  movement  of  the  limb,  and 
the  patient  at  once  conveyed  to  a  place  where  he  can  se- 
cure the  proper  surgical  treatment,  for  wounds  of  this 
character  are  frequently  associated  with  Tetanus  or  lock 
jaw. 

When  a  person  has  been  bitten  by  a  snake,  the  wound 
should  be  immediately  applied  to  the  mouth,  and  the 
poison  removed  by  suction.  If  the  wound  be  inaccessible 
to  the  patient  himself,  this  may  be  done  by  some  one  else 
present  if  he  is  willing  to  assume  the  risk.  It  is  believed 
that  the  venom  has  no  effect  upon  the  mucous  mem- 
brane of  the  mouth  unless  cuts  or  abrasions  are  present. 
If  an  extremity  is  bitten,  in  addition  to  suction,  the  part 
should  be  immediately  surrounded  by  a  tight  bandage  be- 
tween the  wound  and  the  heart.  This  is  an  effort  to  pre- 
vent the  absorption  of  the  poison  into  the  system.  It 
should  not  be  forgotten  that  the  bandage  must  occasion- 
ally be  loosened  to  prevent  any  serious  interference  with 
the  general  circulation  of  the  part.  Cauterization  would 
be  of  no  value  in  this  variety  of  poisoned  wound.  The 
depression  that  follows  the  absorption  of  the  poison  de- 
mands the  free  use  of  stimulants — whisky  or  brandy; 
however,  it  is  not  necessary  or  proper  that  the  patient 
should  be  made  intoxicated.  Ammonia  is  a  very  valuable 
remedy,  and  may  be  given  in  the  form  of  the  carbonate 
of  ammonia,  ten  or  fifteen  grains  in  whisky  every  half- 
hour,  or  the  spirits  of  ammonia  (hartshorn)  may  be  sub- 
stituted ;  one  half  to  one  teaspoonf ul  may  be  administered 
in  water  or  diluted  whisky.  If  necessary,  stimulants 
(properly  diluted)  may  be  given  by  the  rectum,  but 
always  in  larger  doses.  A  very  valuable  method  of  ad- 
ministering the  different  stimulants  is  that  commonly 
used  by  physicians,  viz.,  by  the  hypodermic  syringe,  and  is 


100  PROMPT  AID  TO  THE  INJURED. 

often  resorted  to  when  a  patient  can  not  easily  swallow, 
or  where  the  prompt  action  of  the  remedy  is  demanded. 
(See  Medic ATiox.) 

The  treatment  of  a  wound  caused  by  the  bite  of  a  dog 
supposed  to  be  suffering  from  rabies  (hydrophobia)  is 
substantially  the  same  as  in  snake-bites,  although,  if  suc- 
tion is  impracticable,  the  wound  may  be  cauterized  by 
heating  the  blade  of  a  penknife,  button-hook,  or  piece  of 
wire,  red-hot  and  applying  it  to  the  wounded  surface. 
The  poison  introduced  does  not  develop  rapidly,  and  the 
constitutional  symptoms  may  not  appear  for  weeks;  there- 
fore stimulants  are  only  indicated  when  shock  is  present. 
The  suspected  animal  should  be  at  once  closely  confined 
until  under  professional  guidance  it  is  killed  and  speci- 
mens secured  and  forwarded  to  some  laboratory  where 
they  can  be  properly  examined  to  detect  the  presence  of 
rabies  if  it  exists.  The  Pasteur  treatment  of  this  injury, 
by  the  injection  of  the  anti-rabic  emulsion,  is  now  regarded 
as  a  successful  and  scientific  procedure,  if  promptly  em- 
ployed, and  the  patient  should  immediately  be  subjected 
to  it;  fortunately,  this  may  now  be  carried  out  with  but 
little  difficulty. 

The  wounds  caused  by  tarantulas,  centipedes,  spiders, 
bees,  wasps,  and  other  insects,  are  very  rarely  dangerous. 
The  local  application  of  dilute  ammonia,  or  a  solution  of 
bicarbonate  of  soda,  is  regarded  as  the  most  effective  rem- 
edy, and  generally  relieves  the  pain  at  once.  Wet  fresh 
earth,  common  salt,  or  a  slice  of  an  onion  are  also  valu- 
able, or  some  soothing  application,  such  as  solutions  con- 
taining sugar  of  lead,  laudanum,  etc.,  that  may  be  pro- 
cured, can  be  substituted.  Stimulants  may  be  indicated 
in  some  cases. 

Wounds  of  the  abdominal  walls  are  very  dangerous, 
particularly  so  if  the  injury  extends  to  the  abdominal 
cavity  (which  is  frequently  the  case),  the  external  open- 
ing being  often  sufficiently  large  to  allow  of  the  escape  of 
the  bowels  or  intestines.     If  this  occurs  the  mass  should 


CONTUSIONS  AND  WOUNDS.  IQl 

be  covered  with  clean  cloths,  wrung  out  of  hot  water  for 
protection  until  the  arrival  of  the  surgeon.  Over  this  ap- 
plication should  be  placed  other  material,  which  tends  to 
retain  the  warmth  and  offer  gentle  support.  A  wound  of 
the  abdominal  walls  which  does  not  enter  the  cavity, 
although  dangerous,  should  be  treated  as  an  ordinary- 
wound.  The  shock  which  accompanies  abdominal  wounds 
must  receive  appropriate  treatment. 

Wounds  of  the  thorax  or  chest  are  often  associated 
with  injury  to  the  lung.  Should  this  complication  exist, 
it  can  be  recognized  by  pain  and  irritation,  coughing,  dif- 
ficult breathing,  haemoptysis  (spitting  of  blood),  and  the 
appearance  of  blood  and  mucus,  and  sometimes  air  at  the 
external  opening. 

When  this  condition  is  present,  the  external  wound 
should  be  closed  and  a  compress  and  bandage  firmly  ap- 
plied, and  the  patient  placed  in  a  recumbent  position  and 
treated  in  the  manner  already  described  (see  Hemopty- 
sis). Should  great  distress  follow,  the  dressing  must  be 
removed,  and  the  patient  turned  on  the  side  correspond- 
ing to  the  wound,  thus  favoring  the  escape  of  accumu- 
lated blood  in  the  chest,  which  probably  caused  the  op- 
pression. 

Rest  is  essential  to  the  proper  healing  of  wounds,  and 
should  be  insisted  upon,  particularly  if  the  injury  is  of  a 
serious  nature.  The  limbs  may  be  kept  quiet  by  the  use 
of  splints  or  slings. 

Gangrene^  or  mortification,  is  a  condition  representing 
destruction  or  death  of  the  soft  tissues,  and  is  analagous 
to  necrosis  in  bone.  It  may  affect  a  small  part,  as  a 
crushed  toe,  or  involve  a  whole  extremity.  The  latter 
often  happens  when  the  main  artery  of  the  arm  or  leg  is 
torn  across  as  a  result  of  an  injury,  or  when  this  vessel 
is  subjected  to  prolonged  pressure;  this  sometimes  occurs 
when  a  bandage  has  been  too  tightly  applied. 

Among  the  most  prominent  signs  of  gangrene  are  per- 
sistent loss   of  heat   and   sensation^   pallor   of   the   part, 


102  PROMPT  AID  TO  THE  IXJUPvED. 

which  later  becomes  dusky  and  mottled,  purplish,  and  at 
the  end  almost  black.  Decomposition  or  putrefaction  and 
the  formation  of  offensive  gases  follow.  The  presence  of 
the  gases  gives  a  crackling  sensation  to  the  touch. 

The  condition  just  described  is  known  as  moist  gan- 
grene, and  is  the  form  usually  met  with.  This  term  is 
used  to  distinguish  it  from  a  less  common  variety,  known 
as  dry  gangrene,  or  inummificaHon.  This  occurs  in  very 
old  people,  where  the  arteries  are  more  or  less  diseased 
and  the  circulation  is  weak.  It  usually  affects  the  toes, 
and  develops  very  slowly.  As  the  name  implies,  the  af- 
fected tissue  has  the  appearance  of  being  dried  and  shriv- 
eled. 

A  bedsore  is  a  localized  form  of  gangrene,  appearing 
about  the  buttock,  along  the  spine,  shoulders,  and  elbows, 
caused  by  long-continued  pressure  on  these  prominences 
in  invalids  who  are  confined  to  the  bed,  and  who  are  often 
in  an  emaciated,  enfeebled,  or  paralyzed  condition. 

In  order  to  prevent  the  formation  of  bedsores,  strict 
cleanliness  should  be  observed;  the  bed  must  be  soft,  and 
smoothly  made;  pressure  on  the  exposed  parts  must  be 
avoided.  An  air-cushion  beneath  the  sheets  is  a  valuable 
means  of  preventing  pressure,  or,  if  possible,  the  patient 
should  at  certain  intervals  change  his  position  in  the  bed, 
or,  best  of  all,  be  placed  on  a  water-bed.  Feather  beds 
should  always  be  avoided  for  the  sick.  The  skin  over  the 
exposed  part  should  be  hardened  by  bathing  the  exposed 
part  twice  daily  with  alcohol,  cologne  water,  etc. 

Treatment. — Gangrene  represents  dead  tissue,  and 
must  be  removed  as  early  as  possible. 

Gangrenous  extremities  are  amputated  by  the  surgeon. 
In  these  cases  a  fatal  result  often  follows,  owing  to  the 
absorption  of  septic  or  poisonous  matter  into  the  system. 

Small  gangrenous  spots,  such  as  follow  the  lesser  in- 
juries, and  also  bedsores,  are  usually  left  to  Nature  to  re- 
move the  dead  tissue.  This  is  done  by  a  process  known 
as  "  sloughing."    The  treatment  during  this  period  should 


CONTUSIONS  AND   WOUNDS.  103 

be  directed  toward  assisting  Nature,  by  the  use  of  warm 
applications  such  as  carbolized  flaxseed  poultices,  which 
facilitate  the  removal  of  the  "  slough,"  and  by  cleaning 
out  the  discharge  with  warm  antiseptic  solutions.  The 
latter  agents  also  diminish  the  offensive  odor  which  is 
always  present.  When  the  slough  or  gangrenous  matter 
has  been  cleared  away  the  granulation  and  healing  should 
be  stimulated  by  the  application  of  carbolic  or  oxide-of- 
zinc  ointment,  balsam  of  Peru,  iodoform,  etc.,  and  the  ap- 
propriate dressing  applied. 

Dry  or  senile  gangrene  is  a  slow  process,  and  the  treat- 
ment should  be  left  with  the  surgeon,  if  possible;  if  not, 
the  following  simple  measures  may  be  observed.  In  the 
early  stage,  when  the  big  toe  (the  common  seat  of  the 
affection)  is  first  involved,  the  part  should  be  enveloped 
in  cotton  batting  to  preserve  an  even  temperature,  and 
the  foot  should  be  kept  quiet;  later,  when  decomposition 
occurs,  antiseptic  solutions  should  be  applied. 


CHAPTER   X. 

HEMORRHAGE. 

HEMORRHAGE  is  the  escape  of  blood  as  the  result  of  an 
injury  to  a  blood-vessel,  and  is  classified  as  arterial^  venous, 
and  capillary. 

In  arterial  haemorrhage  the  blood  is  thrown  from  the 
injured  vessel  in  jets  or  spurts,  and  has  a  bright-red  or 
scarlet  color. 

In  venous  haemorrhage  the  blood  flows  from  the  wound 
in  a  slow,  steady  stream,  the  color  being  dark  red  or 
purple. 

In  capillary  haemorrhage  the  blood  oozes  from  the 
general  surface  of  the  wound  and  not  from  one  point,  as  in 
arterial  or  venous  haemorrhage — the  color  being  dark  red. 

Hgemorrhage  is  arrested  in  two  ways — by  natural,  and 
by  artificial  means. 

The  Natural  Mean^s. — The  natural  means  of  arrest- 
ing arterial  haemorrhage  is  as  follows  :  After  an  artery 
has  been  entirely  divided,  its  muscular  coat  produces  a 
contraction  and  retraction  of  the  vessel  at  the  seat  of  in- 
jury. The  contraction  duninishes  the  diameter  of  the 
artery,  while  the  retraction  draws  the  end  of  the  di^dded 
vessel  backward  into  its  sheath.  The  blood  at  the  mouth 
of  the  bleeding  vessel  forms  a  coagulum  or  ''  clot,"  which 
aids  in  preventing  the  further  escape  of  blood.  Exposure 
of  the  bleeding  surface  to  the  air,  and  in  severe  heemor- 
rhage  the  weakened  force  of  the  heart  and  circulation, 
which  often  results  in  syncope  or  fainting,  greatly  favor 
the  formation  of  the  clot,  and  consequently  help  to  arrest 


HEMORRHAGE.  1C5 

the  haemorrhage.  The  clot  at  the  mouth  of  the  injured 
vessel  subsequently  becomes  organized  and  fii'nil y  attached, 
and  permanently  stops  the  l)leeding.  When  an  artery  is 
only  partly  divided,  the  contraction  and  retraction  can  not 
properly  take  place,  and  the  haemorrhage  is  very  persist- 
ent. If  an  artery  is  severed  by  a  dull  or  rough  instrument, 
or  torn  across,  the  fibers  at  the  end  of  the  vessel  being 
ragged  and  uneven,  more  effectually  close  the  opening  and 
assist  in  the  formation  of  a  clot,  and  may  arrest  haemor- 
rhage even  in  large  arteries.  This  is  illustrated  in  ma- 
chinery accidents,  where  an  arm  has  been  torn  from  the 
body  and  followed  by  very  little  or  no  bleeding. 

The  manner  in  which  nature  arrests  venous  haemor- 
rhage is  by  the  contraction  and  retraction  of  the  end  of 
the  bleeding  vessel,  with  the  formation  of  a  clot,  as  above 
detailed  in  arterial  haemorrhage,  and  also  the  collapse  of 
the  vein  at  the  point  of  injury  (see  Veins).  The  blood- 
pressure  in  veins  being  mucii  less  than  that  of  arteries, 
the  haemorrhage  is  less  vigorous  and  more  easily  con- 
trolled. 

In  capillary  haemorrhage  the  minute  size  of  the  vessels 
and  the  contraction  that  follows  their  division,  together 
with  the  rapid  formation  of  a  clot,  particularly  when  the 
bleeding  surface  is  exposed  to  the  air,  usually  check  the 
haemorrhage  in  a  very  short  time. 

In  some  persons  a  condition  of  the  blood  exists  which 
retards  or  prevents  the  formation  of  a  clot ;  for  this  reason 
the  most  trivial  wound  may  be  followed  by  a  haemorrhage 
which  can  not  be  arrested,  and  terminates  fatally.  These 
subjects  are  known  as  bleeders.  Cases  of  this  kind  are 
fortunately  rare. 

The  Artificial  Means.— The  artificial  means  of  arrest- 
ing haemorrhage  are  as  follows  :  Position,  pressure,  cold 
and  heat,  torsion,  rest,  styptics,  and  ligation. 

Treatment  of  Arterial  Hcemorrhage.  Position.— Eleva- 
tion of  the  injured  part  aids  in  controlling  arterial  haemor- 
rhage only  where  very  small  vessels  are  involved,  but  is 


106  PROMPT  AID   TO   THE   INJURED. 

of  very  little  value  where  large  ones  are  implicated,  owing 
to  the  strong  pressure  of  blood  in  the  arteries. 

Pressure. — This  method  of  arresting  haemorrhage  is, 
next  to  ligation,  the  most  important  means  that  can  be  em- 
ployed for  this  purpose.  It  may  be  applied  directly  to  the 
bleeding  surface,  or  along  the  coiu^se  of  the  artery.  In  the 
latter  instance  the  j)ressure  should  be  always  made  between 
the  ivound  and  the  heart.  In  the  first  variety  of  pressure 
the  finger  (digital  pressure),  or  a  pledget  or  tampon  (see 
Tampons),  is  pressed  into  the  wound,  and  constitutes  a 
valuable  means  of  checking  the  fiow  of  blood,  particularly 
from  small  arteries.  Pressure  with  the  fijiger  can  only 
be  of  avail  for  a  short  time,  unless  the  one  making  the 
pressure  can  be  relieved  at  brief  intervals.  For  this 
reason,  a  tampon — if  properly  applied — is  more  effective 
than  digital  pressure,  provided  the  surgeon  is  not  ex- 
pected for  some  time,  or  in  case  it  is  necessary  to  move  the 
patient. 

In  tamponing,  the  wound  should  be  thoroughly  filled 
from  the  bottom.  A  tampon  improperly  applied  is  worse 
than  useless.  The  material  used  for  this  purpose  must  be 
absolutely  clean,  and  if  possible  made  antiseptic  (see  Anti- 
septics). Should  the  surroundings  permit,  choice  should 
be  made  of  one  of  the  following  :  small  strips  of  anti- 
septic gauze,  linen,  or  muslin,  or  absorbent  cotton.  After 
the  above  has  been  complied  with,  the  tampon  should  be 
held  firmly  in  place  by  a  bandage  (see  Bandages),  but 
should  not  be  allowed  to  remain  longer  than  twelve  or 
fifteen  hours  without  the  advice  of  a  sm'geon.  If  the 
haemorrhage  recurs  at  the  expiration  of  this  time,  it  may 
be  necessary  to  clean  the  wound  and  apply  a  fresh  tam- 
pon, otherwise  it  should  receive  the  attention  of  an  or- 
dinary wound. 

The  second  variety  of  pressure  (along  the  course  of  an 
artery)  is  used  particularly  in  haemorrhage  from  large  ar- 
teries, and  is  most  serviceable  when  the  vessel  can  be 
pressed  against  a  bone.     Either  the  finger  (digital  press- 


HAEMORRHAGE.  107 

ure),  (Tr  a  pad  or  compress  (see  Compresses),  may  be  used 
for  this  purpose. 

If  the  surgeon  is  expected  to  arrive  in  a  sliort  time, 
digital  pressure  is  the  simplest,  quickest,  and  best  means 
that  can  be  employed.  However,  if  consideral^le  time 
must  elapse  before  the  patient  can  receive  the  proper  sur- 
gical attention,  or  if  he  is  to  be  removed  some  distance, 
the  pad  should  be  utilized. 

In  digital  pressure,  the  thumb  should  preferably  be  used. 

The  function  of  a  pad  applied  over  the  course  of  a  bleed- 
ing artery  is  similar  to  that  of  a  tourniquet.  A  tourniquet 
is  an  instrument  used  by  surgeons  to  arrest  arterial  haem- 
orrhage by  compression. 

An  excellent  tourniquet  can  be  extemporized  by  folding 
a  large  handkerchief  in  the  form  of  a  cravat,  placing  be- 
tween the  folds  a  smooth  stone,  piece  of  wood,  cork,  potato, 
etc.,  or  a  good-sized  knot  may  be  tied  in  the  handkerchief; 
the  latter,  however,  is  inferior  to  the  stone,  etc.  The  hand- 
kerchief is  then  bound  loosely  around  the  limb  and  tied, 
the  portion  acting  as  the  pad  being  placed  over  the  artery, 
betiveen  the  icound  and  the  hearty  and  held  securely  in  this 
position,  while  a  bayonet,  sword,  cane,  umbrella,  stick  of 
wood,  etc.,  should  be  passed  between  the  handkerchief  and 
the  skin  at  the  side  of  the  limb  opposite  the  pad  and  twisted 
until  the  haemorrhage  ceases  (Fig.  72).  As  the  constric- 
tion resulting  from  this  form  of  pressure  interferes  with 
the  return  or  venous  circulation,  the  handkerchief  should 
be  occasionally  loosened  if  there  is  evidence  of  serious 
obstruction,  as  swelling  and  blueness  of  the  part  below 
the  constriction  ;  digital  pressure  should  be  substituted 
while  the  handkerchief  is  loose.  A  handkerchief  is  given 
as  an  illustration  of  what  may  be  at  once  secured,  although 
parts  of  clothing,  neck-ties,  suspenders  or  rubber  tubing^ 
rope,  etc.,  are  equally  valuable,  provided  they  fulfill  the  re- 
quirements. Haemorrhage  may  be  checked  without  the 
pad  by  simply  constricting  the  part  with  one  of  the  agents 
just  enumerated.     This,  however,  is  less  effective. 


108 


PROMPT   AID   TO   THE   INJURED, 


Prof.  Esmarch  has  recently  devised  a  suspender  made 
of  elastic  webbing,  and  so  constructed  that,  after  detaching 

it  from  the  trousers,  the  apparatus 
(straps,  etc.),  by  which  it  is  attached, 
can  be  easily  and  quickly  removed, 
leaving  a  long  elastic  ribbon  which 
is  to  be  used  in  constricting  a  bleed- 
ing limb  (Fig.  65). 

Torsion  is  a  method  used  by  sur- 
geons to  check  bleeding  from  small 
arteries.  It  consists  in  catching  the 
end  of  the  injured  vessel  with  for- 
ceps or  clamp  and  twisting  it  until 
the  haemorrhage  ceases. 

Ligation  or  ligaturing  (tjong)  is 
the  procedure  by  which  the  end 
of  the  bleeding  vessel  is  tightly 
constricted  and  secui'ely  closed  by 
an  agent  called  a  ligature,  which 
consists  of  a  thread  of  silk,  cat- 
gut, etc.  A  ligature  is  commonly 
employed  to  arrest  hasmorrhage 
(particularly  in  arteries),  and  is 
the  most  valuable  method  of  ac- 
complishing this  result.  The  use 
of  this  means,  however,  should  re- 
main within  the  province  of  the 
surgeon. 

Treatment  of  Venous  Hmmor- 
rhage.  Venous  haemorrhage  is  easi- 
ly controlled  if  the  following  rules 
are  observed  : 

Fig.  65.-Suspeader  devised       -^    Remove  everything  between 
y   ro  .    smarc  .        ^^^  icoiuid  and  the  heart  that  re- 
tards the  flow  of  blood,  as  garters,  tight  clothing,  etc. 

2.  Elevate  the  injured  part. 

3.  Apply  a  good  firm  compress  directly  to  the  wound. 


HJiMORIlIIAGE.  lUl) 

Coiistriction  of  the  limb  beyond  or  helow  the  seat  of 
haemorrhage  is  vahiable,  but  inferior  to  the  method  just 
described. 

The  importance  of  the  first  and  second  rules  will  be 
apparent  in  rupture  of  varicose  veins  in  the  leg,  which 
often  bleed  freely ;  the  valves  of  these  disabled  veins  being 
rendered  useless,  the  blood  escapes  from  both  ends  of  the 
divided  vessel.  In  rupture  of  varicose  veins  of  the  leg  a 
bandage  should  be  applied  over  the  compress,  beginning  at 
the  toes  and  extending  upward  to  a  short  distance  above 
the  seat  of  haemorrhage.  In  ordinary  venous  haemorrhage 
the  free  return  of  blood  to  the  right  side  of  the  heart,  aided 
by  elevation  of  the  limb,  relieves  the  blood-pressure  in  the 
veins  in  the  immediate  vicinity  of  the  wound,  and  conse- 
quently the  haemorrhage  is  not  so  profuse. 

Treatment  of  Capillary  Hceniorrhage.  Capillary 
haemorrhage  is  usually  harmless,  except  in  case  of  ''  bleed- 
ers," and  generally  ceases  when  the  bleeding  surface  is 
exposed  to  the  air.  If  such  means  are  not  successful,  hot 
or  cold  applications  or  a  compress  should  be  employed. 

Cold  is  a  very  valuable  means  of  controlling  venous 
and  capillary  haemorrhage,  and  aids  in  arresting  the 
bleeding  from  an  artery.  It  may  be  applied  in  the  form 
of  cold  air  (exposure  of  the  bleeding  surface),  cold  water, 
ice,  and  snow. 

Hot  applications  (temperature  120°  to  125°  Fahr.)  are  su- 
perior to  cold.  A  piece  of  flannel  wrung  out  in  water  as 
hot  as  can  be  borne  by  the  skin,  and  applied  directly  to  the 
bleeding  surface,  is  followed  by  a  diminution  or  a  cessation 
of  haemorrhage.  Both  hot  and  cold  applications  contract 
the  bleeding  vessels  and  hasten  the  formation  of  the  clot. 

The  application  of  alcoholic  solutions,  or  the  spirits  of 
turpentine,  to  the  wound  by  a  cloth  saturated  with  either, 
although  very  irritating,  are  sometimes  used  to  check 
haemorrhage. 

Styptics,  or  astringents,  although  powerful  agents  for  ar- 
resting haemorrhage,  are  used  by  surgeons  with  great  reluc- 


110  PROMPT   AID   TO   THE  INJURED. 

taiice  and  only  in  special  cases,  or  where  other  means  are 
not  available  or  less  effective.  Styptics  are  objectionable,  for 
the  reason  that  the  stronger  ones,  as  solution  of  the  subsul- 
phate  of  iron  (Monsel's  solution),  nitrate  of  silver,  and  some 
others,  injure  the  wounded  surface,  and  may  be  followed 
by  sloughing.  The  weaker  styptics  or  astringents,  such  as 
tannin,  gallic  acid,  matico,  cobwebs,  and  alum,  prevent  heal- 
ing by  first  intention.  Alum  is  the  least  objectionable  of 
the  latter  group.  The  application  of  styptics  to  mucous 
membranes  (mouth,  nose,  etc.)  is  followed  by  more  favor- 
able results  than  when  applied  to  a  raw,  wounded  surface. 

Rest  is  extremely  important  in  all  varieties  of  haemor- 
rhage, as  it  favors  the  formation  and  retention  of  the  clot. 

Haemorrhage  occurring  in  the  scalp  may  be  easily 
arrested  by  the  use  of  a  compress  and  bandage  (see  Band- 
ages), which  press  the  bleeding  vessels  against  the  under- 
lying skull. 

Haemorrhage  from  the  mouth  may  usually  be  stopped 
by  the  use  of  ice  and  astringent  (alum,  tannin)  or  alcohoKc 
(brandy,  whisky,  etc.)  solutions ;  if  not  suflBcient,  a  tampon 
should  be  fii^mly  held  against  the  bleeding  point.  In  severe 
cases  the  common  carotid  artery  (see  description  of  this  ves- 
sel), on  the  side  corresponding  to  the  injury,  may  be  com- 
pressed, although  this  should  only  be  used  as  a  last  resort. 

The  lips  are  supplied  by  arteries  which  divide  at  the 
angles  of  the  mouth,  and  entirely  surround  this  opening. 
When  the  lips  have  been  injui'ed,  the  haemorrhage  i^iay 
be  checked  by  pressing  the  sides  of  the  wound  between  the 
thumbs  and  fingers. 

Severe  haemorrhage  following  the  extraction  of  a  tooth 
can  be  conti'olled  by  replacing  the  tooth,  or  by  the  applica- 
tion of  a  tampon  saturated  with  a  strong  solution  of  alum, 
or  other  astringent,  to  the  cavity. 

Epistaxis^  or  ''nose-bleed,"  is  the  most  frequent  form  of 
internal  haemorrhage,  and  may  be  controlled  in  the  fol- 
lowing manner :  Elevation  of  the  head  and  arms,  removal 
of  all  constriction  about  the  neck,  cold  applications  to  the 


HEMORRHAGE.  m 

back  of  the  neck,  forehead,  or  bridge  of  the  nose.  Passing 
two  fingers  beneath  the  upper  lip  and  directing  pressure 
against  the  base  of  the  nose  or  nostrils  is  very  useful ; 
snuffing  up  some  finely  powdered  tannin  or  cold,  salt,  or 
alum  water,  or,  even  better,  syringing  the  nasal  cavity 
with  some  of  these  remedies.  If  the  mouth  is  kept  open 
during  this  operation,  the  fluid  will  escape  through  the 
opposite  nostril.  A  very  valuable  method  of  checking 
epistaxis  is  by  the  use  of  a  thin  rubber  finger-cot  or  pro- 
tector, which  should  be  greased  and  carefully  passed  into 
the  nasal  cavity  of  the  affected  side  ;  after  the  cot  is  in 
position  it  should  be  filled  or  partly  filled  with  very  small 
pieces  of  ice.  In  severe  cases  of  epistaxis  which  resist  the 
remedies  already  enumerated,  the  nasal  cavity  on  the  side 
corresponding  to  the  haemorrhage  may  be  tamponed  by 
carrying  into  the  nasal  cavity  of  the  affected  side  a  piece 
of  gauze  (antiseptic,  if  possible)  over  a  pencil  or  similar 
agent.  When  the  pencil  is  withdrawn  the  cavity  left  in 
the  gauze  is  packed  with  small  pieces  of  cloth  or  cotton. 
The  tampon  sliould  be  left  a  number  of  hours,  and  never 
forcibly  removed,  but  should  be  loosened  by  injection  of 
water  or  oil. 

In  order  to  be  able  to  properly  control  haemorrhage  by 
pressure,  it  will  be  necessary  to  know  the  position  of  cer- 
tain arteries  and  their  relation  to  contiguous  structures, 
so  that  they  may  be  readily  found  and  compressed.  For 
this  purpose  the  following  diagrams  have  been  intro- 
duced, which  will  afford  a  guide  in  locating  these  blood- 
vessels. 

Carotid  Artery. — This  vessel  supplies  the  head  with 
arterial  blood.  Its  course  from  below  upward  corre- 
sponds to  a  line  drawn  from  the  junction  of  the  collar 
and  breast  bones  (clavicle  and  sternum)  upward  to  a 
point  just  behind  the  angle  of  the  lower  jaw,  or  between 
it  and  the  mastoid  process  of  the  skull — a  bony  promi- 
nence just  back  of  the  ear  ;  this  line  also  indicates  very 
closely  the  anterior  or  front  border  of  the  sterno-mastoid 


112  PROMPT   AID   TO   THE   INJURED. 

muscle,  which  extends  from  the  mastoid  process  to  the 
sternal  end  of  the  clavicle  already  mentioned. 

The  application  of  digital  pressure  to  the  carotid  artery- 
is  indicated  in  severe  haemorrhage  about  the  head  and 


Fig.  67. — Digital  compression  of  carotid  artery. 

upper  part  of  the  neck  (as  in  "  cut  throat "),  which  can  not 
be  controlled  by  other  means.  The  pressure  should  be 
applied  about  midway  in  the  neck  at  the  anterior  border 
of  the  sterno-mastoid  muscle,  and  directed  against  the 
anterior  portion  of  the  spinal  column  in  the  neck  (Fig. 
67).  The  carotid  artery  is  accompanied  by  a  large  vein 
(internal  jugular)  and  a  very  important  nerve  (pneumo- 
gastric)  which  may  be  injured  if  the  part  be  roughly 
manipulated. 

In  wounds  of  the  hand,  forearm,  and  arm,  associated 
with  severe  arterial  hgemorrhage,  pressure  may  be  made 
upon  the  subcla\dan,  axillary,  brachial,  or  radial  and  ulnar 
arteries,  according  to  the  situation  of  the  wound. 

Subclavian  Artery. — Pressure  should   be  applied  to 


HiEMOllRUAGE. 


113 


this  vessel  in  haemorrhage  occurring  at  the  upper  part  of 
the  arm  or  in  the  axillary  space  ("arm-pit").     The  outer 


Fig.  68.— Digital  compression  of  subclavian  artery. 

portion  of  the  subclavian  artery  passes  over  the  upper  sur- 
face of  the  first  rib.  If  the  thumb  is  directed  downward  j 
beind  the  clavicle,  about  two  inches  from  the  breast-bone, 
the  artery  may  be  reached  and  compressed  against  thft/ 
first  rib  (Fig.  68).  Pushing  the  shoulder  of  the  patienfi 
downward  facilitates  this  procedure.  In  some  persons 
digital  pressure  fails  to  arrest  the  haemorrhage,  as  the  ar- 
tery can  not  be  reached  by  the  finger ;  then  the  handle  of 
a  door-key  or  some  other  agent  suitable  for  the  purpose 
may  be  substituted. 

Axillary  Artery.  —  This  vessel    is    the   continuation 
downward  of  the  subclavian  artery.     It  passes  through  the 
axillary  space,  and  can  not  be  easily  compressed  in  this 
9 


114 


PROMPT   AID   TO  THE  INJURED. 


situation  ;  consequently,  the  subclavian  is  generally  se- 
lected as  the  artery  to  which  pressure  is  to  be  applied  in 
haemorrhage  occurring  in  the  upper  part  of  the  arm. 
Some  pressure  may  be  made  upon  the  axillary  artery  by 
raising  the  patient's  arm  and  pressing  the  vessel  against 
the  upper  and  inner  portion  of  the  humerus.     A  book,  or 

whatever  may  be  used,  should 
be  carried  well  up  into  the 
axillary  space,  and  the  arm 
brought  close  to  the  side.  It 
should  be  remembered  that 
undue  pressure  at  this  point 
may  injure  some  of  the  nu- 
merous nerves  in  this  vicinity. 
Brachial  Artery. — Owing 
to  the  numerous  injuries  of 
the  upper  extremity,  the  bra- 
chial artery  requires  compres- 
sion oftener  than  any  other 
vessel  in  the  body.  Pressure 
upon  the  brachial  artery  is 
easily  and  accurately  made. 
Its  course  is  along  the  inner 
side  of  the  biceps  muscle, 
which  is  found  in  the  front 
of  the  arm  and  stands  out 
very  prominently,  particular- 
FiG.  69.— Line  showing  the  course  of  ly  in  muscular  Subjects  (Fig. 
the  brachial  artery.  gg^      Pressure  should  be  ap- 

plied at  the  inner  border  of  the  biceps  and  directed  against 
the  humerus  (Fig.  70).  If  the  patient  is  to  be  removed,  a 
tourniquet  should  be  made  and  adjusted  in  the  manner 
already  described,  or  two  round  pieces  of  wood  about  the 
diameter  of  a  broomstick,  and  properly  covered  to  prevent 
injury  to  the  skin,  may  be  used  to  compress  the  brachial 
artery.  One  piece  should  be  placed  transversely  on  the 
inner  side  of  the  arm  against  the  artery,  while  the  other 


HiEMORRHAGE. 


occupies  a  corresponding" 
position  on  the  outer  side 
of  the  arm;  the  ends  of 
the  sticks  are  then  tied 
to^-ether  with  suflBLcient 
force  to  arrest  the  haemor- 
rhage. 

Haemorrhage  in  the 
forearm  and  hand  may  be 
controlled  by  placing  a 
small  pad  at  the  bend  of 
the  elbow,  and  then  flexing 
(bending)  the  forearm  upon 
the  arm  and  keeping  it  in 
this  position. 

The  radial  and  ulnar 
arteries  are  branches  of  the 
brachial,  and  continue 
down  the  forearm  to  the 
hand;  they  are  superficial 
at  the  wrist,  the  only  point 
at    which     they     can    be 

compressed  with  any  degree  of  success.  The  radial  artery 
or  "  pulse  "  may  be  found  about  three  quarters  of  an  inch 
from  the  outer  border  of  the  wrist  (when  the  palm  of  the 
hand  is  turned  upward),  the  ulnar  being  about  one  half 
inch  from  the  inner  border  of  the  wrist.  These  vessels 
may,  to  a  certain  extent,  be  compressed,  but  in  wounds  of 
the  hand  associated  with  haemorrhage  pressure  upon  the 
brachial  artery  should  be  employed. 

A  very  persistent  form  of  haemorrhage  sometimes  fol- 
lows a  wound  of  the  palm  of  the  hand.  The  bleeding 
should  be  checked  by  plugging  the  wound  and  then  placing 
in  tlie  palm  of  the  injured  hand  over  the  tampon  a  smooth 
and  round  piece  of  wood,  potato,  apple,  lemon,  billiard- 
ball,  or  whatever  may  be  closely  grasped.  Tlie  hand 
sliould  then  be  bandaged  in  this  position.    The  h^mor- 


FiG.  70.— Digital  compression  of  bra- 
chial artery. 


116 


PROMPT   AID   TO   THE  INJUREDo 


rhage  may  be  greatly  climinislied  or  even  controlled  by 
having  the  patient  hold  tightly  one  of  the  agents  just  men- 
tioned, without  the  addition  of  the  tampon. 

Femoral  Artery. — After  the  external  iliac  artery  (in 
the  abdominal  cavity)  passes  into  the  leg,  it  is  known  as 

the  femoral  artery  and  supplies 
the  lower  extremity.  It  should  be 
compressed  in  severe  hsemorrhage 
from  this  portion  of  the  body. 
The  course  of  this  artery  is  from 
the  middle  of  the  groin  downward 
to  the  inner  side  of  the  knee  (Fig. 
71).  The  artery  is  superficial  in 
the  upper  part  of  the  thigh,  from 
the  groin  downward  about  six  or 
eight  inches,  and  it  is  in  this  situa- 
tion that  the  pressui'e  must  be  ap- 
plied (Figs.  72  and  73).  It  is  com- 
pressed most  effectively  where  it 
crosses  the  pelvic  bone  at  the 
"groin." 

Popliteal  Artery. — This  vessel 
is  the  continuation  of  the  femoral 
artery,  and  is  found  in  the  poplit- 
eal space  (behind  the  bend  of  the 
knee),  and  is  only  slightly  affected 
by  digital  pressure,  although  a  pad 
can  be  placed  in  the  popliteal  space 
and  pressed  upon  the  artery  by  flexing  the  leg  upon  the 
thigh  and  securing  it  in  this  position. 

Haemorrhage  from  the  sole  of  the  foot  is  sometimes 
controlled  by  compressing  the  posterior  tibial,  sl  branch 
of  the  popliteal  artery,  as  it  winds  around  the  ankle  be- 
tween the  internal  malleolus  (ankle)  or  lower  end  of  the 
tibia,  and  the  heel,  rather  closer  to  the  former.  Plugging 
is  also  valuable  for  this  form  of  haemorrhage. 

Secondary  haemorrhage  means  the  reappearance  of 


Fig.  71. — Line  showing  course 

of  the  femoral  arterv. 


HAEMORRHAGE. 


117 


bleedfng  in  the  wounded  part  soon  after  it  lia.s  been  once 
arrested.  It  is  generally  capillary,  and  is  caused  by  the  re- 
action and  increased 
force  of  the  heart,  the 
relaxation  of  the  blood- 
vessels at  the  seat  of  in- 
jury, or  the  immoderate 
use  of  stimulants,  undue 
movement  of  the  part, 
and  also  increased 
warmth  to  the  surface 
that  follows  when  the 
patient  is  placed  in  bed. 

Elevation  of  the  in- 
jured part  and  moderate- 
ly increased  pressure  are 
often  all  that  need  be 
done,  although,  if  the 
haemorrhage  continues, 
the  dressings  should  be 
removed,  the  blood- clots 
cleaned  out  of  the 
wound,  and  fresh  dress- 
ings applied.  Seconda- 
ry haemorrhage  may  also 
occur,  when  sloughing 
is  present,  some  days  after  the  wound  is  received. 

It  should  be  well  borne  in  mind  that  secondary  haemor- 
rhage may  be  followed  by  collapse  and  death. 

Clots  are  not  to  be  removed  from  a  wound  unless  the 
means  of  cleaning  and  dressing  the  wound  are  at  hand ; 
they  act  as  a  temporary  compress  and  haemostatic. 

The  constitutional  symptoms  of  haemorrhage  follow- 
ing a  great  loss  of  blood  are  :  Pallor  of  the  face,  lips,  and 
surface  of  the  body,  the  skin  being  often  covered  with  a 
cold  sweat;  the  features  are  pinched.  Thirst,  shortness  of 
breath,  restlessness  and  sighing,  vomiting,  and  disturbance 


Fig.  72. 


-Digital  compression  of  the  fem- 
oral artery. 


118 


PROMPT    AID   TO   THE   INJURED. 


of  the  functions  of  the  brain,  are  more  or  less  prominent ; 
dimness  of  vision,  ringing  in  the  ears,  delirium,  and  un- 
consciousness or  syncope,  convulsions,  and  death  may  also 

occur.  The  se- 
verity of  these 
symptoms  de- 
pends upon  the 
amount  of  haem- 
orrhage. 

The  treatment, 
besides  checking 
the  hemorrhage, 
consists  in  the 
careful  internal 
useof  stimulants, 
application  of 
warmth  to  the 
body,  hot  rectal 
injections,  and 
the  general  treat- 
ment of  shock. 

Hcemoptysis. 
or  hemorrhage 
from  the  lungs, 
is  generally  rec- 
ognized by  the  expectoration  of  bright-red  and  frothy 
blood,  also  coughing,  and  pain  and  rattling  in  the  chest. 
The  usual  cause  is  disease  of  the  lungs,  although  it  may 
follow  a  wound  of  these  organs. 

Treatment. — The  fears  of  the  patient  should  be  calmed, 
and  rest  in  the  recumbent  position,  with  the  head  and 
shoulder  slightly  elevated,  insisted  upon.  The  tempera- 
ture of  the  room  should  be  cool,  and  the  air  pure.  Among 
the  remedies  commonly  used  are  table  salt,  half  a  tea- 
spoonful  ;  cracked  ice  ;  ten  to  sixty  drops  of  the  fluid  ex- 
tract of  ergot  every  hour  for  two  or  three  hours,  and  then 
discontinued  or  taken  at  longer  intervals  ;  five  to  twenty 


Fig. 


'3. — Arresting  haemorrhage  from  femoral  artery 
by  the  use  of  an  improvised  tourniquet. 


HEMORRHAGE.  1 19 

drops  of  the  oil  of  turpentine  on  sugar  every  half  hour 
or  hour  until  three  or  four  doses  have  been  taken,  or  half 
a  teaspoonful  of  aromatic  sulphuric  acid  (elixir  of  vit- 
riol), in  water  occasionally.  If  the  affected  side  is  known 
an  ice-bag  may  be  applied.  Slight  haemorrhage  from  the 
lungs  is  sometimes  relieved  by  the  free  use  of  a  cathartic. 
Hwmopiysis  is  rarely  followed  hy  a  fatal  termination,  un- 
less it  results  from  a  wound  of  the  lung. 

Hcematemesis,  or  haemorrhage  into  the  stomach  and 
vomiting  of  blood,  is  generally  the  result  of  some  chronic 
disease  of  the  stomach,  although  it  may  follow  a  blow  or 
stab  of  the  abdomen.  The  symptoms  are  frequently  those 
of  profuse  haemorrhage  (see  Constitutional  Symptoms  of 
Hemorrhage),  also  a  sense  of  fullness  about  the  stomach, 
commonly  followed  by  the  vomiting  of  dark  or  black 
blood,  which  is  heavy,  not  frothy,  as  in  haemoptysis.  The 
vomited  matter  is  mixed  with  food,  provided  the  haemor- 
rhage occurs  soon  after  a  meal.  It  should  be  remembered 
that  the  source  of  haemorrhage  in  haematemesis  may  be 
from  the  mouth,  nose,  or  throat,  the  blood  having  been 
swallowed,  consequently  these  parts  should  be  examined. 

The  usual  treatment  is  rest  in  the  recumbent  position; 
small  pieces  of  ice  should  be  freely  swallowed,  and  the  ap- 
plication of  ice  wrapped  in  a  towel  or  in  an  ice-bag,  or 
snow,  cold  water,  etc.,  over  the  stomach;  hot  applications 
may  be  applied  to  the  extremities.  No  attempt  should  be 
made  to  administer  medicine  or  stimulants  by  the  mouth. 
In  severe  cases  of  haemoptysis  and  haematemesis  the  gen- 
eral treatment  of  shock  is  called  for.  Stimulants  should 
be  used  with  caution,  as  they  are  apt  to  encourage  the 
haemorrhage.  Hsematemesis  is  commonly  associated  with 
some  serious  condition.  The  patient  should  be  seen  by  a 
physician  as  promptly  as  possible. 


CHAPTEE   XL 

FRACTURES. 

A  FRACTURE  is  a  breaking'  or  solution  of  continuity 
in  a  bone. 

Fractures  are  generally  classified  as  simple,  compound, 
comminuted,  multiple,  and  complicated. 

In  a  simple  fractui'e  the  bone  is  broken  into  two  frag- 
ments, but  does  not  communicate  with  the  outer  world, 
the  skin  being  uninjured. 

In  a  compound  fracture  the  bone  is  exposed  to,  or  com- 
municates with,  the  air  by  a  wound  of  the  soft  structures. 

In  a  comminuted  fractui'e  the  bone  is  broken  or 
crushed  into  a  number  of  pieces  at  the  same  point,  and 
communicating  with  each  other. 

In  a  multiple  fracture  the  bone  is  broken  into  a  num- 
ber of  pieces,  but  at  different  parts  of  the  bone,  and  not 
communicating  with  each  other. 

In  a  complicated  fracture  there  is,  in  addition  to  the 
breaking  of  a  bone,  an  injury  to  some  important  adjacent 
structure  resulting  from  the  fracture,  as  blood-vessels, 
nerves,  or  joints. 

A  fracture  is  either  complete  or  incomplete.  A  com- 
plete fracture  is  the  usual  variety,  and  involves  the  entire 
separation  or  loss  of  continuity  of  a  bone.  An  incom- 
plete fracture  frequently  occurs  in  children,  owing  to  the 
elasticity  of  bone  in  eai'ly  life,  and  has  received  the  name 
of  ''  green-stick  "  fractm^e. 

The  direction  in  which  the  bone  is  fractured  is  indi- 
cated by  the  terms  transverse,  oblique,  and  longitudinal. 

An  impacted  fracture  occurs  when  the  broken  ends  of 
a  bone  are  driven  into  each  other,  and  remain  thus  fixed. 


FRACTURES.  121 

The'  sign  and  symptoms  of  a  fracture  are  deformity, 
abnormal  or  increased  mobility,  bony  crepitus,  pain,  loss 
of  function,  and  subsequent  swelling  and  discoloration. 

The  deformity  is  caused  by  the  displacement  of  the 
broken  ends  of  the  bone,  as  the  result  of  the  violence  caus- 
ing the  injury,  also  the  vigorous  muscular  contraction  at 
the  affected  i)art,  and  attempted  movement  on  the  i)art  of 
the  patient,  Avhich  cause  a  shortening  and  change  in  the 
direction  of  the  limb,  and  considerable  deformity  at  the 
seat  of  injury.  The  deformity,  as  a  rule,  is  not  particu- 
larly apparent  in  impacted  fractures. 

Abnormal  mobility  is  the  result  of  the  solution  of  con- 
tinuity or  break  in  the  bone,  producing  a  "  false  point  of 
motion,"  which  is  detected  by  the  surgeon  while  manipu- 
lating the  part. 

Crepitus,  or  grating,  is  caused  by  the  rubbing  together 
of  the  broken  ends  of  the  bone,  and,  when  detected,  is  a 
positive  sign  of  fracture ;  it  is  absent  in  impacted  f ractm-e, 
and  also  where  muscular  or  other  tissues  have  fallen  be- 
tween the  ends  of  the  broken  bone  ;  consequently,  an 
absence  of  crepitus  does  not  mean  an  absence  of  fracture. 

Pain  is  caused  by  the  contact  of  the  fragments  of  bone 
with  the  adjacent  structures,  also  the  strong  muscular  con- 
traction that  occurs  at  the  seat  of  injury.  More  or  less 
heat,  redness,  swelling,  and  discoloration  of  the  part  may 
be  present. 

Loss  of  function  is  the  inability  on  the  part  of  the 
patient  to  make  use  of  the  affected  limb. 

The  swelling  and  discoloration  are  due  to  the  subcuta- 
neous escape  of  blood  and  serum  at  the  seat  of  fracture. 

The  repair,  union,  or  "  knitting  "  of  the  bone  is  begun 
by  Nature  soon  after  the  occurrence  of  a  fracture,  and  is 
accomplished  by  a  substance  formed  at  the  seat  of  injury, 
known  as  callus,  which  is  thrown  around  and  between  the 
ends  of  the  broken  bone.  Although  soft  at  first,  the  callus 
gradually  hardens,  and  at  the  end  of  varying  periods,  de- 
pending on  the  bone  injured,  but  not  usual'ly  exceeding 


122  PROMPT   AID   TO   THE   IXJUPiED. 

six  weeks,  the  fragments  are  firmly  united.  The  minute 
structure  of  callus  becomes  in  time  (about  one  year)  simi- 
lar to  that  of  bone. 

Sometimes  the  formation  of  callus  is  imperfect  or  in- 
sufficient, and  the  broken  bone  does  not  become  united. 
This  "condition  constitutes  an  ununited  fracture. 

The  union  of  bone  in  a  simple  fracture  is  likened  to 
heahng  by  first  intention  in  wounds,  while  the  repair  in  a 
compound  fracture  resembles  healing  by  granulation.  The 
popular  belief  that  the  pain  is  increased  at  the  seat  of  fract- 
ure during  the  ''  knitting  "  or  healing  process  is  without 
any  foundation. 

Treatment.  — The  object  of  a  surgeon  in  treating  a 
fracture  is  simply  to  assist  Nature.  He  first  carefully 
reduces  the  fracture,  or  "sets"  the  bone;  that  is,  he  en- 
deavors, as  far  as  possible,  to  bring  the  broken  extremities 
in  apposition  or  directly  against  each  other,  and  by  retain- 
ing them  in  position  for  a  certain  length  of  time  by  splints 
or  some  other  form  of  support,  the  permanent  union  is 
effected  by  the  callus,  and  the  function  of  the  part  gener- 
ally restored. 

Although  it  is  best  that  a  fracture  should  be  reduced 
and  the  proper  dressing  applied  as  quickly  as  possible  after 
the  accident,  it  should  be  remembered  that  the  union  of  the 
fragments  does  not  begin  for  some  time  after  the  injury, 
and  that  a  fracture  may  remain  several  days  before  being 
reduced,  and  be  stni  followed  by  excellent  results  ;  and 
also  that  a  frequent  cause  of  compound  fractm^e  is  the  out- 
come of  unskillful  manipulation.  Consequently,  when 
one  not  a  surgeon  is  called  upon  to  attend  a  person 
where  a  fracture  is  suspected,  his  duty  consists  in  protect- 
ing and  making  immovable  the  injured  part,  and  convey- 
ing the  subject  to  a  hospital,  or  wherever  he  can  receive 
the  necessary  and  proper  treatment.  However,  should 
this  be  impossible,  as  the  result  of  the  accident  having 
occurred  where  the  professional  services  can  not  be  pro- 
cured for  an  indefinite  period,   an  effort  may  then  be 


FRACTURES.  123 

madelo  reduce  the  fracture,  but  the  manipulations  are  to 
be  made  only  with  the  greatest  care. 

As  a  rule,  an  injured  person  should  not  be  removed 
from  the  position  in  which  he  is  found  until  an  examina- 
tion has  been  made  as  to  the  character  of  the  injury.  A 
violation  of  this  rule  is  a  frequent  cause  of  a  compound 
fracture. 

A  brief  account  of  the  manner  in  which  the  injury  was 
received  should  be  obtained  from  the  patient  or  a  by- 
stander. An  examination  should  then  be  made.  If  the 
injury  is  about  the  ankle  or  wrist,  it  can  easily  be  exposed ; 
however,  if  the  affected  part  is  nearer  to  the  body,  the 
clothing  should  be  cut  away,  and  not  removed  in  the  ordi- 
nary manner,  which  would  be  likely  to  disturb  the  frag- 
ments and  increase  the  suffering.  The  different  garments 
need  not  be  indiscriminately  cut,  but,  if  possible,  ripped 
at  the  seams. 

If  a  fracture  has  occurred,  an  examination  will  probably 
show  one  or  more  of  the  ordinary  symptoms  and  signs 
already  described.  If  the  necessary  surgical  attendance 
can  be  secured  within  a  number  of  hours,  the  splints  should 
be  applied  without  an  attempt  being  made  to  reduce  the 
fracture  ;  otherwise,  an  effort  in  this  direction  is  justifiable. 

The  reduction  of  a  fracture  consists  in  bringing  the 
ends  of  the  broken  bone  together,  and  is  accomplished  by 
extension  and  counter-extension.  The  term  extension, 
when  applied  to  the  treatment  of  a  fracture,  indicates  a 
procedure  whereby  the  broken  limb  below  the  seat  of 
fracture  is  pulled  from  the  body.  In  counter-extension, 
the  upper  fragment,  or  the  portion  of  the  broken  bone 
nearest  the  body,  is  held  securely  in  position,  or  is  carried 
in  an  opposite  direction  from  the  lower  fragment.  This 
manner  of  reducing  a  fracture  is  performed  by  the  sur- 
geon with  the  hands  or  an  instrument  devised  for  the 
purpose.     The  hands  are  generally  used. 

The  extension  and  counter-extension  should  be  made  in 
a  straight  line ;  that  is,  in  the  long  axis  of  the  broken  bone. 


124 


PROMPT   AID   TO   THE  INJURED. 


After  the  seat  of  injury  has  been  examined,  and  the 
presence  of  a  fracture  ascertained  or  suspected,  the  cloth- 
ing j)reviously  turned  aside  can  now  be  replaced  and 
\^'rapped  around  the  i)art,  thus  affording  considerable  pro- 
tection to  it.  The  splint  should  then  be  adjusted,  and  the 
patient  removed  to  a  place  where  he  can  receive  the  prop- 
er surgical  treatment. 

The  slings  necessary  to  support  an  injured  arm  have 
already  been  described  (see    Triangular   and    Cravat 

Bandages).  In  addition  to 
these,  the  skii't  of  the  coat 
may  be  utilized  for  this  pur- 
pose (Fig.  74) ;  also  other  de- 
vices, such  as  pinning  the 
sleeve  to  the  waist,  etc. 

If  the  fracture  is  com- 
pound, no  effort  should  be 
made  to  apply  splints  until 
the  wound  has  been  covered 
as  quickly  as  possible  with  an 
antiseptic  material  or  some 
form  of  clean  dressing.  When 
a  blood-clot  fills  the  wound, 
it  should  under  no  circum- 
stances be  disturbed  until  the 
patient  is  in  the  hands  of  the 
surgeon.  The  protection  af- 
forded by  the  compress  or 
blood-clot  just  alluded  to,  pre- 
vents the  entrance  of  poison- 
ous germs  into  the  system. 
If  a  point  of  the  broken  bone 
is  pushed  through  the  skin,  it 
should  not  be  interfered  with,  but  dressed  antiseptically. 

Splints. — Splints  can  be  made  of  any  material  which 
is  capable  of  rendering  the  part  practically  immovable 
without  injuring  the  soft  structures  to  which  they  are  ap- 


Fia.  74.— Skirt  of  coat  used  as  a  slino;. 


FRACTURES.  125 

plied^  They  should  be  long  enough  to  extend  some  dis- 
tance above  and  below  the  injury,  and  generally  including 
the  nearest  joint,  and  at  times  two  or  three  joints,  as  in 
fracture  of  the  thigh.  Their  diameter  should  exceed  that 
of  the  limb  to  which  they  are  applied,  although  this  is 
not  absolutely  necessary,  as  a  cane  or  a  sword  makes  a 
very  fair  support.  Two  splints  are  generally  used,  one  for 
the  inner  and  one  for  the  outer  side  of  the  limb.  Splints 
should  always  be  padded  on  the  side  next  to  the  skin  with 
some  soft  material,  so  as  to  prevent  undue  pressure  and  in- 
jury. After  a  splint  has  been  fitted  to  the  limb,  it  should 
be  retained  by  the  necessary  bandages;  the  latter,  how- 
ever, should  not  surround  the  limb  at  the  point  of  fract- 
ure, nor  should  they  be  drawn  sufficiently  tighi:  to  increase 
the  suffering  of  the  patient.  This  should  be  particularly 
observed  in  unreduced  fractures. 

Although  thin  wooden  boards  are  regarded  as  the  most 
desirable  material  for  splints  (at  least  for  temporary  use), 
being  light,  and  easily  formed  to  suit  special  cases,  other 
substances  may  be  employed  with  good  results.  Among 
those  Avhicli  can  be  secured  in  emergencies  are  shingles, 
laths,  fence-boards,  cigar-boxes,  barrel-staves,  bark  and 
branches  of  trees,  the  latter  being  bound  together  with 
cord  or  green  twigs.  Binders'  board,  cut  into  the  proper 
shape,  makes  an  excellent  splint.  Book-covers  may  be 
used  ;  also  sole-leather,  newspapers  tightly  and  thickly 
folded,  hay  or  straw  bound  in  the  same  manner  as  the 
branches  of  trees;  canes,  umbrellas,  broomsticks,  coat-  or 
shirt-sleeves  or  boot-legs  stuffed  with  hay,  grass,  leaves, 
etc.,  can  be  utilized.  A  pillow,  or  an  article  of  clothing 
properly  folded,  makes  a  very  valuable  temporary  splint 
and  pad  combined,  and  is  particularly  useful  in  fracture 
of  the  leg  (Fig.  79). 

In  military  service,  in  addition  to  the  above  articles, 
guns,  swords,  scabbards,  bayonets,  leather  from  a  saddle, 
etc.,  can  be  made  available. 

Padding. — For  padding,  cotton  or  any  soft  substance, 


126  PROMPT   AID   TO   THE   INJURED. 

as  an  article  of  clothing,  oakum,  furniture-stuffing,  straw, 
hay,  moss,  grass,  leaves,  etc.,  may  be  used- 
Bandages  for  the  purpose  of  retaining  the  splint  may 
be  formed  of  handkerchiefs,  neck-ties,  suspenders,  strips  of 
clothing,  straps,  green  twigs,  rope,  cord,  wire,  etc.  Care 
should  be  taken  that  when  using  such  substances  which 
are  small,  as  wire  and  cord,  that  the  skin  he  well  protected, 
so  that  it  shall  not  he  injured  or  cut. 

Special  fractures  will  now  be  considered. 
Fractures  of  the  cranial  bones  are  usually  followed 
hy  symptoms  of  concussion  and  compression  of  the  brain. 
A  fracture  occurring  at  the  base  of  the  skull  is  usually 
caused  by  a  blow  about  the  forehead  or  opposite  the  point 
of  fracture,  or  by  a  fall  from  a  height,  the  person  striking 
on  the  head  or  upon  the  feet  or  buttocks,  and  has,  in  addi- 
tion, special  symptoms  which  point  directly  to  this  form 
of  injury,  viz. ,  an  escape  of  blood  from  the  nose  and  ear, 
and  heneath  the  thin  membranes  covering  the  eye  ;  or, 
what  is  still  more  positive,  an  escape  of  a  colorless  fluid 
from  the  ear. 

Treatment. — The  patient  should  be  placed  on  his  hack 
in  a  cool^  dark  room,  and  kept  perfectly  quiet.  Cold,  in 
some  form,  should  he  applied  to  the  head,  to  prevent  ex- 
cessive reaction.  For  the  same  reason,  the  internal  use  of 
stimulants  is  to  be  avoided. 

Fracture  of  the  inferior  maxillary  bone  (lower 
jaw)  is  caused  hy  kicks,  blows,  or  falls.  The  body  of  the 
bone  (the  portion  into  which  the  teeth  are  inserted)  is  the 
usual  seat  of  fracture,  which  is  generally  compound,  hav- 
ing a  communication  with  the  cavity  of  the  mouth.  The 
deformity  is  shown  by  the  u'regular  line  of  the  teeth  on 
the  aflPected  side.  Crepitus,  swelling,  dribbling  of  saliva, 
and  bleeding  from  the  mouth,  are  also  generally  present. 

Treatment. — The  teeth  should  he  brought  together, 
thus  allowing  the  superior  maxillary  bone  (upper  jaw)  to 
act  as  a  splint.  A  four-tailed  bandage  (Fig.  43)  should 
then  he  applied  to  retain  the  parts  in  this  position. 


FRACTURES.  127 

Fracture  of  thk  spinal  column  should  be  suspected 
when,  following  an  injury  to  the  back,  there  appears  more 
or  less  paralysis  beloiv  the  point  of  injury  (paraplegia),  as 
the  result  of  pressure  upon  the  spinal  cord.  The  ordinary 
symptoms  of  fracture  are  not  usually  present,  nor  should 
they  be  sought  for,  as  efforts  made  to  elicit  crepitus,  etc., 
might  increase  the  injury  to  the  spinal  cord.  Paraplegia 
may  also  be  caused  by  a  dislocation  of  the  vertebrae. 

Treatment. — The  patient  should  be  allowed  to  assume 
the  position  (lying  down)  which  is  most  agreeable  to  him, 
provided  he  does  not  lie  face  downward.  An  ice-bag,  or 
some  form  of  cold,  may  be  applied  to  the  seat  of  injury,  and 
perfect  rest  enjoined.  If  necessary,  the  patient  can  be  moved 
on  a  stretcher  which  is  so  prepared  that  undue  movement 
of  the  spine  is  prevented  (see  Transportation).  The  after- 
treatment,  consisting  of  efforts  made  to  adjust  the  frag- 
ments of  bone  and  to  prevent  subsequent  inflammation 
and  injury  to  the  spinal  cord,  and  relieving  the  paralyzed 
bladder  of  urine,  should  be  attended  to  only  by  a  surgeon. 

Fractures  of  the  ribs  are  caused  by  direct  or  indirect 
violence,  as  the  result  of  a  fall  or  a  blow,  or  being  sub- 
jected to  severe  x^ressure,  as  in  a  crowd,  or  by  muscular 
contraction.  Muscular  action  during  a  paroxysm  of  cough- 
mg  or  sneezing,  has  been  known  to  produce  a  broken  rib. 
The  seat  of  fracture  is  usually  between  the  third  and 
eighth  ribs,  and  about  on  a  line  downward  from  the 
axillary  space.  The  floating  ribs — eleventh  and  twelfth — 
are  rarely  broken,  owing  to  their  single  attachment  (verte- 
bral column),  which  allows  sufficient  freedom  whereby  to 
escape  injury. 

Fractured  ribs  are  usually  diflB.cult  to  recognize,  in  a 
large  number  of  cases  the  injury  being  mistaken  for  con- 
tusions. 

Embarrassed  and  shallow  breathing,  associated  with  a 
sharp  and  lancinating  or  "  stabbing  "  pain  at  the  injured 
part,  or  a  "  stitch  in  the  side,"  is  almost  alwaj^s  complained 
of.     Crepitus  may  sometimes  be  detected  by  placing  the 


128  PROMPT  AID   TO   THE  INJURED. 

hand  or  the  ear  against  the  injured  side,  and  then  having 
the  patient  take  a  long  breath  or  cough.  It  is  uncommon 
to  find  any  external  evidence  of  fracture,  and  great  care 
should  be  observed  in  examining  so  as  not  to  inflict  a 
greater  injury  by  the  manipulation. 

A  broken  rib  may  be  followed  by  serious  consequences, 
as  an  injury  to  the  lung,  which  w^ould  be  demonstrated  by 
shock,  spitting  of  blood,  and,  in  some  cases,  a  crackling  sen- 
sation when  the  hand  is  carried  over  the  skin  at  the  seat  of 
pain,  due  to  the  presence  of  air  under  the  skin  (emphysema). 

Treatment. — The  treatment  consists  in  limiting  the  ac- 
tion of  the  affected  side  or  sides  as  much  as  possible.  This 
indication  is  met  by  the  application  of  bandages  or  adhe- 
sive plaster.  A  triangular  bandage,  folded  in  the  form  of 
a  cravat,  and  bound  snugly  around  the  chest,  would  answer 
for  a  temporary  dressing ;  a  flannel  or  muslin  bandage, 
about  three  inches  wide,  and  made  to  encircle  the  chest  a 
number  of  times,  would  be  still  better.  At  the  present 
time,  however,  the  most  effective  means  of  treating  a  frac- 
tured rib  is  by  the  use  of  adhesive  plaster,  applied  either 
entirely  or  two  thirds  of  the  way  around  the  chest  as  fol- 
lows :  Strips  of  plaster,  one  and  a  half  or  two  inches  wide, 
and  sufficiently  long  to  surround  the  entire  chest,  are 
made  ready.  The  strips  are  heated  and  then  applied 
firmly  around  the  chest  from  above  downward,  follow- 
ing, as  nearly  as  possible,  the  course  of  the  ribs,  each 
strip  overlapping  the  lower  third  of  the  preceding  one. 
The  space  covered  by  the  strips  should  be  about  eight 
inches  in  width.  Or,  for  instance,  if  the  fracture  is  on 
the  right  side,  the  adhesive  plaster  may  be  first  applied 
about  four  inches  to  the  left  of  the  spinal  column,  and 
carried  around  the  right  side  of  the  chest  to  about  the 
same  distance  to  the  left  of  the  breast-bone,  thus  restrain- 
ing the  action  of  the  injured  side  without  materially 
affecting  the  opposite  one.  In  the  use  of  bandages  or  the 
strips  of  plaster,  as  already  described,  it  is  very  important 
that  they  (particularly  the  plaster  strips)  should  be  ap^ 


FRACTURES. 


120 


plied  at  the  end  of  expiration,  as  at  this  time  the  chest  is 
diminished  in  size  and  the  broken  fragments  are  brought 
closer  together ;  however,  care  must  be  taken  that  the 
application  does  not  seriously  interfere  with  respiration. 

The  above  treatment  may  also  be  used  in  severe  con- 
tusions of  the  chest. 

Fracture  of  the  Clavicle. — The  collar-bone  is  more 
frequently  broken  than  any  other  bone  in  the  body,  and 
is  usually  the  result  of  indirect  violence,  as  falling  upon 
the  shoulder.  The  recoil  of  a  gun  may  cause  direct  fract- 
ure. It  will  be  remembered  that  the  collar-bones  hold 
the  shoulders  upward,  backward,  and  outward;  conse- 
quently, the  deformity  following  this  injury  would  be 
dropping  of  the  shoulder  downward,  forward,  and  in- 
ward, with  some  change  in  the  outline  at  the  site  of  the 
fracture. 

Treatment. — The  patient  may  be  laid  down,  with  a 
pillow  between  the  shoulders,  or,  if  he  is  to  be  removed, 
the  following  temporary  sup- 
port may  be  used  :  A  soft  pad 
is  placed  well  up  in  the  ax- 
illa or  arm-pit,  the  forearm 
being  laid  against  the  chest 
and  the  shoulder  raised  by 
pressing  the  elbow  upward, 
and  held  in  this  manner  by 
an  assistant,  or  by  the  patient 
himself,  until  supported  by 
the  bandages  to  be  now  de- 
scribed. A  triangular  or  Es- 
march  bandage,  folded  in  the 
form  of  a  cravat,  or  a  long 
strip  of  cloth,  should  be  placed 
under  the  elbow,  and  one  end 
carried  upward,  across  the 
chest,  and  the  other  across  the 

back,  and  the  two  ends  fastened  over  the  opposite  shoul- 
der ;  a  similar  bandage  is  then  placed  against  the  outside 
10 


Fig.  75. — Temporary  dressing  for 
fracture  of  clavicle. 


130  PROilPT  AID   TO   THE   INJURED. 

of  the  arm,  on  the  injured  side  ;  the  ends  of  the  second 
bandage  are  carried  across  the  chest  and  fastened  at  the 
opposite  side.  The  dressing-  fulfills,  to  a  great  extent,  the 
indications  for  treatment,  viz.,  carrying  the  shoulder  up- 
ward, backward  and  outward  (Fig.  75). 

Fracture  of  the  Scapula  or  shoulder-blade  is  of  rare 
occurrence,  and  the  result  of  du'ect  violence,  as  a  heavy- 
wagon- wheel  passing  over  the  part. 

The  signs  and  symptoms  are  usually  obscure,  the  bone 
being  so  thickly  covered  with  muscular  tissue  that  it  does 
not  exhibit  much  deformity. 

Treatment. — In  a  suspected  fracture,  the  arm  of  the 
corresponding  side  should  be  placed  in  a  sling  and  kept 
quiet  by  the  side  of  the  chest. 

Fracture  of  the  Humerus  or  arm-bone  may  be  the 
result  of  direct  or  indnect  violence  or  of  muscular  con- 
traction. The  signs  and  symptoms  are  usually  well 
marked,  and  there  is  considerable  shortening.  If  the  seat 
of  fracture  is  at  the  surgical  neck,  a  bony  prominence  may 
be  found  in  the  axillary  space  or  arm-pit. 

Treatment. — When  reduction  is  to  be  made,  the  fore- 
arm and  elbow  should  be  pulled  downiward  (extension), 
the  shoulder  acting  as  the  counter  -  extension.  If  the 
fracture  is  about  the  middle  of  the  bone,  an  internal  and 
external  splint  should  be  applied.  Great  care  must  be 
taken  least  the  internal  one  should  be  carried  into  the  arm- 
pit and  made  to  press  upon  important  blood-vessels  and 
nerves.  If  the  fracture  is  in  the  upper  part  of  the  bone, 
through  the  surgical  neck,  a  soft  pad  may  be  placed  in  the 
arm-pit  aud  held  in  place  by  a  flgure-of-8  bandage,  or 
spica,  around  the  shoulder.  The  hand  and  wrist  only 
should  be  suspended  in  a  sling,  thus  allowdng  the  elbow- 
to  drop,  thereby  diminishing  the  tendency  to  shortening 
of  the  arm. 

Fracture  of  the  Forearm  generally  occurs  at  the 
lower  end  of  the  radius,  about  two  inches  or  less  from  the 
joint,  and  is  known  as  Colles'  or  "  silver-fork "  fracture. 


FRACTURES.  131 

It  receives  the  latter  name  from  the  peculiar  appearance 
about  the  wrist,  which  has  a  fancied  resemblance  to  a  sil- 
ver fork.  Colles'  fracture  is  almost  as  frequent  as  fracture 
of  the  clavicle,  and  is  g-enerally  impacted. 

Treatment. — The  arm  should  be  placed  at  right  angles, 
the  thumb  pointing  toward  the  chin — midway  between 
pronation  and  supination.  An  internal  splint,  extending 
from  the  upper  part  of  the  forearm  to  the  wrist,  and  an 
external  splint  extending  to  the  base  of  the  fingers,  should 
be  applied.  Care  should  be  taken  that  the  internal  splint 
does  not  press  upon  the  vessel  at  the  bend  of  the  elbow. 

Eeduction  may  be  accomplished  as  f  ollo\^^s :  Should  the 
fracture  be  on  the  right  side,  for  instance,  the  attendant 
should  grasp  the  right  hand  of  the  patient  with  the  corre- 
sponding one  of  his  own,  and  extension  be  carefully  made ; 
counter-extension  being  performed  with  the  left  hand, 
which  grasps  the  forearm  above  the  seat  of  fracture. 

Fracture  of  the  Middle  of  the  Forearm  may  occur 
as  the  result  of  direct  violence.  One  or  both  bones  may  be 
broken.  When  the  latter  occurs,  the  appearance  is  very 
characteristic.  However,  w^hen  either  the  radius  or  ulna 
is  broken,  the  companion-bone  acts  as  a  splint,  and  the  de- 
formity and  other  signs  are  not  so  marked.  In  fracture 
of  the  shaft  of  the  radius,  which  is  uncommon,  the  usual 
symptoms  of  fracture  are  noted,  and,  in  addition,  the  loss 
to  a  greater  or  less  degree  of  pronation  and  supination,  or 
turning  the  hand  inward  and  outward.  Fracture  of  the 
ulna  sometimes  follows  an  attempt  to  ward  off  a  blow,  and 
is  not  uncommon  among  pugilists. 

Treatment. — Fracture  at  the  middle  of  the  forearm 
should  be  treated  in  the  manner  already  described  for 
Colles'  fracture  —  internal  and  external  splints  applied 
while  the  arm  is  bent  at  an  angle,  with  the  thumb  point- 
ing to  the  chin,  the  injured  limb  then  being  supported  by 
a  sling. 

Fracture  of  the  Metacarpal  Bones.— Indirect  vio- 
lence, as  a  fall  upon  the  hand,  or  striking  a  blow  with  the 


132  PROMPT   AID   TO  THE  INJURED. 

fist,  is  a  common  cause  of  fracture  at  tins  situation.  A 
swelling  on  the  back  or  dorsum  of  the  hand  usually  fol- 
lows, and  the  knuckle  corresponding  to  the  broken  meta- 
carpal bone  is  sunken,  and  appears  to  be  effaced. 

Treatment. — A  roller-bandage,  wad  of  cotton,  oakum, 
or  other  similar  material,  or  a  potato,  lemon,  tennis  ball, 
etc.,  should  be  placed  in  the  palm,  the  hand  closed,  and 
retained  in  this  position  by  a  bandage. 

Fractures  of  the  Phalanges  are  generally  detected 
without  much  difficulty,  the  common  signs  of  fracture 
being  well  marked. 

Treatment. — After  reduction  has  been  accomplished, 
splints  should  be  applied  to  the  palmar  and  dorsal  sides  of 
the  broken  finger.  A  piece  of  a  cigar-box  may  be  used  for 
this  purpose,  although  a  piece  of  tin  or  sheet-zinc,  entirely 
covered  with  adhesive  plaster,  would  be  preferable;  or, 
after  the  fracture  is  reduced,  the  finger  may  be  bound  to  a 
companion  finger,  or  covered  with  a  narrow  roller-bandage, 
and  stiffened  (after  being  applied)  with  flour  and  white  of 
an  egg,  which  makes  a  very  good  temporary  dressing. 

Fracture  of  the  Femur  is  one  of  the  common  frac- 
tures of  the  body.  The  great  size  of  the  bone — it  being  the 
largest  in  the  skeleton — and  the  fact  that  more  or  less  limp- 
ing due  to  the  shortening  of  the  affected  limb  may  follow 
this  injury  (particularly  in  the  adult),  makes  the  treatment 
a  matter  of  great  importance  to  the  surgeon.  The  femur 
may  be  broken  either  at  the  neck,  extremities,  or  shaft,  the 
most  frequent  situation  being  about  the  middle  of  the  bone. 
The  fracture  is  more  commonly  caused  by  indirect  violence, 
as  falling,  etc.,  and  is  oblique  (in  adults),  which  principally 
accounts  for  the  shortening  that  follows. 

The  signs  and  symptoms  are  usually  well  marked.  The 
foot  and  leg  are  turned  outward,  particularly  if  the  shaft 
of  the  bone  is  broken.  Fracture  of  the  neck  of  the  femur 
occurs  in  old  people,  and  is  in  a  great  measure  due  to  the 
composition  of  bone  at  this  period  of  life,  which  is  more 
dense  than  at  any  other  time,  and  also  to  the  change  in 


FRACTURES. 


133 


the  ang-le  of  the  iicck  of  the  bone,  and  may  in  the  aged 
follow  a  most  trivial  cause,  as  tripping-,  etc. 

Treatment. — A  long  external  splint,  extending  from 
about  four  inches  below  the  axillary  space  or  arm-pit  to 
a  short  distance  below  the  foot,  is  sufficient  for  a  temporary 
dressing.  If  a  gun  is  used  as  a 
splint,  the  stock  should  be  placed 
beneath  the  arm-pit,  and  the  barrel 
(turned  downward)  laid  against  the 
leg  (Fig.  7Gj.  A  fence-board,  which 
is  usually  about  six  inches  wide, 
makes  an  excellent  splint.  Before 
applying  the  splint,  the  thigh  should 
be  surrounded  by  a  coat  properly 
folded,  or  shawl,  etc.  A  bandage 
should  then  be  carried  around  the 
waist,  two  around  the  thigh  (one 
above  and  one  below  the  seat  of 
fracture),  one  around  the  leg  and 
foot  each — the  bandages  being  tied 
on  the  outside  of  the  splint.  If  no 
better  support  can  be  devised,  the 
affected  limb  may  be  bandaged  to 
the  one  of  the  opposite  side. 

If  a  fracture  of  the  femur  can 
not  be  attended  to  by  a  surgeon 
within  a  short  time,  temporary  ex- 
tension and  counter-extension  can 
be  made.    The  patient,  for  ex- 
ample,  can  be   laid  upon  a 
bed,   the    foot    of    which    is 
raised    six   or   eight   inches, 
thus  carrying    the    body   of 
the   patient  away  from   the 
seat  of  fracture  (counter-ex- 
tension).    A  large  wad  of  cotton,  or  a  fold  of  flannel  or 
other  soft  material,  should  be  wrapped  around  the  ankle 


134 


PROMPT   AID   TO   THE   INJURED. 


and  instep  to  prevent  the  bandage  about  to  be  described 
from  injuring  the  part.  The  next  step  consists  in  arrang- 
ing some  means  by  which  temporary  extension  can  be 
made.  This  indication  is  very  effectively  met  by  the  use 
of  Gerdy's  "  extension-knot,"  which  not  only  holds  the 
foot  in  a  firm  grasp,  but  prevents  the  undue  constriction 
that  would  ensue  if  an  ordinary  knot  were  employed  for 
this  purpose. 

Gerdy's  knot  can  be  made  out  of  a  strip  of  muslin  five 
or  six  feet  long  and  about  six  inches  wide.  This  should 
be  folded  into  a  cravat  (two  inches  in  width). 

The  center  of  the  cravat  is  placed  upon  the  ankle-joint 
behind,  the  ends  being  brought  forward  and  crossed  over 
the  instep.  They  are  then  continued  downward  under  the 
sole  of  the  foot,  recrossed  and  carried  upward  on  the  sides 
to  the  malleoli  (the  bony  prominences  at  the  inner  and 

outer  sides  of  the  ankle-joint), 
and  then  under  the  first  turn 
around  the  ankle  and  down- 
ward, and  tied  below  the  foot 
in  the  form  of  a  loop,  in  order 
that  the  weight  shortly  to  be 
described  may  be  attached  (Fig. 
77).  A  pail,  bag,  or  some  other 
receptacle  should  now  be  pro- 
cured and  in  it  placed  stones 
or  sand,  or  weight  in  some 
form,  amounting  to  from  ten 
to  fifteen  pounds,  and  so  ar- 
ranged that  it  can  be  readily 
attached,  at  the  proper  time,  to 
the  loop  connected  with  the  patient's  foot.  Extension  and 
counter-extension  should  now  be  made  by  the  attendants, 
as  follows  :  While  one  holds  the  body  in  position,  anoth- 
er grasps  the  leg  and  foot  on  the  affected  side,  and  makes 
steady  extension  ;  a  third  attendant  should  place  his 
hands  over  the  seat  of  fracture  to  support  and  protect  it. 


Fig.  77. — Gerdy's  extension-knot. 


FRACTURES. 


L35 


When  the  proper  length  has  been  regained,  or  nearly  so, 
and  while  the  limb  is  held  in  this  position,  the  weight  al- 
ready prepai'ed  should 
be  carefully  and  slowly 
attached.  The  weight 
should  hang  suspend- 
ed over  the  foot-boai'd 
of  the  bed,  if  the  lat- 
ter is  low  enough  (on 
a  level  with  the  affect- 
ed extremity),  or  over 
a  board  placed  upright. 
After  extension  and 
counter  -  extension  are 
made,  and  the  weight 
is  attached,  the  splints 
should  be  applied— 920^ 
before.  If  the  attached 
weight  causes  pain,  it 
should  be  diminished. 

Fracture  of  the 
Leg. — Fractures  of  this 
portion  of  the  body  usu- 
ally affect  both  bones, 
although  either  the 
tibia  or  fibula  may 
alone  be  fractured,  the 
fibula  probably  oftener 
than  the  tibia.  The 
fibula  is  generally  bro- 
ken near  its  lower  ex- 
tremity, and  is  known 
as  Pott's  fracture.  More 
or  less  injury  to  the 
ankle-joints  accompa- 
nies the  latter.  In  fracture  of  both  bones,  which  com- 
monly occurs  about  the  middle,  the  signs  are  generally 


136 


PROMPT  AID   TO    THE   INJURED. 


well  marked,  more  so  than  when  either  the  tibia  or  fibula 
only  is  broken.  Pott's  fracture  is  attended  with  eversion 
or  turning  outward  of  the  foot,  producing  a  characteristic 
deformity. 

Fracture  of  the  tibia,  as  the  result  of  its  superficial  situ- 
ation, is  very  often  compound;  the  wound  communicating 
with  the  fracture  being  frequently  caused  by  efforts  on 
the  part  of  the  patient  to  walk  immediately  after  the 
injury. 

Treatment. — The  limb  should  be  handled  very  care- 
fully, and  an  internal  and  external  splint  applied.  A 
pillow  placed  under  the  leg,  folded  over  the  sides,  and 
properly  retained,  is  particularly  adapted  as  a  temporary 
support  for  this  fracture  (Fig.  79).    If  the  lower  end  of 


Fig.  79.— a  pillow  used  as  a  temporary  splint  in  fracture  of  the  leg. 

the  fibula  is  broken,  and  the  foot  is  turned  outward,  a 
splint,  well  padded,  should  be  placed  along  the  inner  sur- 
face of  the  leg,  extending  from  above  the  knee  to  beyond 
the  foot,  and  the  leg  and  foot  bound  to  it,  thereby  over- 
coming the  tendency  to  eversion. 

Fracture  of  the  patella  may  be  the  result  of  direct  vio- 
lence or  muscular  action.  The  more  common  signs  of  the 
injuries  are  inability  to  straighten  the  leg  ;  the  patient, 
however,  is  able  to  walk  backward.  An  examination 
shows  a  transverse  separation  of  the  knee-cap,  with  an  in- 
terval varying  in  width  between  the  pieces.  The  knee  is 
swollen,  tense,  and  painful.  At  the  moment  of  the  injury 
the  patient  often  hears  a  sudden  snap. 


FRACTURES.  I37 

As  a  temporary  measure,  a  long  posterior  splint  may- 
be applied,  carefully  bound  above  and  below  the  knee. 
Tbe  skill  of  the  surgeon  is  directed  toward  keeping  the 
pieces  in  close  contact  until  union  takes  place. 

The  treatment  of  fractures  of  the  metatarsal 

BONES  AND  PHALANGES  OF  THE  TOES  consists  in  binding 

the  affected  toe  to  the  one  next  to  it,  or  by  supporting  the 

fragments  with  compresses  or  light  splints.     When  the 

foot  is  seriously  injured  by  crushing,  amputation  is  often 

inevitable. 

DISLOCATIONS. 

A  DISLOCATION  or  luxation  is  a  forcible  displacement  of 
one  articular  (joint)  surface  of  a  bone  from  another,  and 
may  be  the  result  of  direct  or  indirect  violence,  or  of  mus- 
cular contraction.  More  or  less  rupture  of  the  ligaments 
always  takes  place.  The  chief  signs  of  a  dislocation  are 
deformity  and  loss  of  function  of  the  joint.  The  mobility 
of  the  part  is  greatly  diminished,  while  in  fractures  there 
is  increased  mobility.  In  dislocation  the  deformitj^  is  at 
the  joint,  while  in  fracture  it  is  usually  about  the  shaft. 

The  reduction  of  a  dislocation  requires  considerable 
technical  skill,  and  should  be  performed  by  a  surgeon. 
Exceptions  to  this  rule,  however,  may  be  made  in  disloca- 
tion of  the  shoulder,  lower  jaiL\  smd  fingers. 

Dislocations  of  the  humerus  usually  take  place  down- 
ward below  the  coracoid  process  (see  Scapula).  The  indi- 
cations for  reduction  are,  to  disengage  the  head  of  the 
humerus  from  its  abnormal  position  by  extension,  coun- 
ter-extension, and  fulcrumage.  This  may  usually  be  ac- 
complished in  the  following  way  :  A  firmly  compressed 
ball  of  cotton  or  similar  material  should  be  placed  in  the 
axilla  or  arm-pit ;  the  attendant  should  then  remove  the 
shoe  from  his  foot  nearest  the  affected  side  of  the  patient 
(facing  the  latter),  and  press  the  heel  upward  against  the 
ball  already  in  the  arm-pit ;  he  should  also  grasp  the  pa- 
tient's hand  and  arm,  and  pull  downward,  thus  making 
extension  and  counter-extension.      In  this  manner  the 


138  PROMPT  AID   TO   THE  INJURED. 

liead  of  the  humerus  is  disengaged,  and,  if  the  foot  of  the 
attendant  can  be  turned  outward  and  the  arm  of  the  pa- 
tient brought  toward  the  chest  during  extension  and 
counter-extension^  the  bone  will  generally  slip  back  into 
its  proper  position.  After  the  reduction  the  arm  should  be 
bandaged  to  the  chest,  to  prevent  redislocation .  It  should 
not  be  forgotten  that  the  axillary  space  contains  many  im- 
portant blood-vessels  and  nerves,  and  too  forcible  manipu- 
lation may  be  followed  by  very  serious  consequences. 

Dislocation  of  the  lower  jaw  (inferior  maxillary 
bone)  is  comparatively  rare.  It  may  be  the  result  of  a 
blow,  but  usually  follows  the  act  of  gaping,  laughing,  or 
vomiting.  The  deformity  is  striking  :  the  jaw  is  pro- 
truded and  remains  open,  the  patient  being  unable  to 
bring  the  teeth  together.  The  articular  surfaces  of  the 
bone  in  this  injury  beuig  carried  foricard,  and  somewhat 
upward,  the  reduction  should  be  accomplished  by  depress- 
ing the  articular  portion  (condyles)  of  the  lower  jaw,  and 
forcing  them  backward.  This  may  be  performed  in  the 
following  manner:  The  patient  should  be  placed  in  a  chaii', 
with  the  operator  standing  before  him,  having  his  thumbs 
wrapped  in  a  handkerchief,  or  some  similar  material,  to 
guard  against  injmy  dm^ing  the  sudden  closure  of  the  pa- 
tient's jaws  at  the  moment  the  dislocation  is  reduced.  The 
attendant  then  places  a  thumb  upon  each  posterior  molar 
tooth  of  the  inferior  maxillary  bone  of  the  dislocated  jaw, 
and  presses  firmly  downward,  and  with  his  fingers  he  tilts 
the  chin  upward.  While  the  bone  is  being  carried  down- 
ward in  this  manner,  a  backward  pressure  with  the  thumbs 
should  then  be  added  which  helps  to  carry  the  articular 
surfaces  to  then'  proper  position.  The  jaw  should  then  be 
held  in  place  by  a  four-tailed  bandage  (Fig.  43). 

Dislocation  of  the  phalanges  may  be  reduced  by 
bending  the  dislocated  bone  further  back,  at  the  same  time 
making  extension  and  counter-extension,  then  suddenly 
flexing  the  joint.  The  subsequent  adjustment  of  a  dorsal 
and  palmar  splint  is  necessary. 


FRACTURES.  139 

SPRAINS. 

A  SPRAIN  is  a  wrenching  or  twisting  of  a  joint,  associ- 
ated with  considerable  stretching,  and  even  tearing,  of  the 
tendons  and  ligaments  of  the  affected  part.  Sprains  usu- 
ally occur  at  the  ankle  or  wrist.  Pronounced  swelling 
and  pain  rapidly  ensue,  and  are  characteristic  of  the  in- 
jury ;  though  it  is  often  difficult  to  diif erentiate  between  a 
sprain,  dislocation,  or  fracture.  The  proper  relation  of  the 
ends  of  the  bone  composing  the  joint,  and  the  absence  of 
the  jDrincipal  signs  of  dislocation  or  fracture,  indicate  that 
a  sprain  exists.  A  sprain  is  always  troublesome,  and  may 
be  followed  by  serious  results,  a  common  sequel  being 
anchylosis,  or  stiffness  of  the  joint. 

Treatment. — When  the  patient  is  seen  soon  after  the 
injury,  the  part  should  be  elevated,  and  a  cold  application 
made,  preferably  the  rubber  bag  (manufactured  for  this 
purpose),  or  a  pig's  bladder  partly  filled  with  cracked  ice. 
Should  neither  of  these  be  obtainable,  the  cracked  ice  may 
be  placed  in  a  handkerchief  or  towel,  and,  if  possible,  the 
dressing  enveloped  with  oiled  silk  or  rubber  cloth.  If  ice 
can  not  be  procured,  cloths  wrung  out  in  cold  water  should 
be  substituted.  A  roller-bandage,  carefully  applied  from 
the  extremity  upward,  is  also  valuable  in  preventing  the 
continuation  of  the  swelling.  The  ice  or  cold-water  appli- 
cations can  be  applied  over  the  bandage ;  it  must,  however, 
be  borne  in  mind  that  a  bandage  that  has  been  wet  will 
shrink,  and  may  make  too  much  pressure,  or  even  cause 
strangulation  of  the  part.  After  the  acute  symptoms  have 
subsided  and  the  heat  and  swelling  have  diminished,  the 
cold  applications  should  be  discontinued  and  gentle  fric- 
tion substituted ;  or  the  joint  may  be  rubbed  with  a  stim- 
ulating lotion,  as  soap-liniment,  alcohol,  or  salt  water. 
Massage  is  also  a  valuable  remedy.  In  severe  sprains 
affecting  the  larger  joints  these  parts  should  be  kept  quiet 
for  two  or  three  weeks,  and  motion  then  be  gradually  per- 
formed. 


CHAPTEE   XII. 
BURNS,  SCALDS,  AND  FROST-BITE. 

BURNS  AND  SCALDS. 

Burns  are  caused  by  the  action  upon  the  tissues  of 
some  form  of  dry  heat,  or  by  a  chemical  agent.  For 
practical  purposes  burns  are  di^nded  into  three  degrees  : 
(1)  Simple  redness  of  the  skin;  (2)  vesication  or  the  for- 
mation of  blisters  ;  (3)  more  or  less  destruction  or  char- 
ring of  the  skin  and  deeper  structui^es.  Burns  of  the  fii'st 
and  second  degrees  are  usually  unattended  by  serious  con- 
sequences, but  when  they  involve  one  half  or  more  of  the 
surface  of  the  body  a  fatal  result  usually  follows.  Burns 
of  the  thu'd  degree  are  dangerous  according  to  then'  situ- 
ation, extent  of  injury,  and  complication.  Burns  of  the 
thoracic  and  abdominal  walls  are  often  attended  with 
great  danger.  Death  following  burns  is  the  result  either 
of  shock  (during  the  first  twenty-four  hours),  internal  in- 
flammation, ulceration  and  haemorrhage,  blood-poisoning, 
tetanus,  or  exhaustion. 

The  temperature  of  the  body  falls  immediately  after  a 
severe  burn  ;  this  is  temporary,  however,  and  is  soon  fol- 
lowed by  more  or  less  fever. 

In  burns  of  the  third  degree,  which  heal  by  granula- 
tion, the  contraction  of  tlie  scar  and  subsequent  deformity 
of  the  part  are  particularly  marked. 

Treatment. — The  treatment  of  burns  is  divided  into 
local  and  constitutional.  The  local  treatment  depends 
upon  the  degree  to  which  it  belongs. 

In  BURNS  OF  THE  FIRST  DEGREE,  remedies  which  are 


BURNS,   SCALDS,   AND   FROST-BITE.  ]41 

sootliiiig  and  protective  ag-ainst  atmospheric  air  and  cold 
should  be  applied.  Among  those  which  generally  can  be 
procured  at  once  are  bicarbonate  of  soda  (common  baking- 
soda,  not  ivashing-socla),  starch,  flour,  chalk,  magnesia,  or 
charcoal.  One  of  these  may  be  thickly  dusted  over  the 
burned  surface.  Vaseline,  cosmoline,  lanoline  (made  from 
wool-grease),  olive,  linseed,  or  castor  oil ;  also  lard  and 
butter,  provided  they  are  not  salted  nor  rancid  ;  white  lead 
paint,  or  lime-water,  whitewash,  or  even  ink,  mucilage,  or 
molasses  may  be  employed,  although  inferior  to  some  others. 

Carbolated  cosmoline,  vaseline,  oil,  lanoline,  etc.,  are 
valuable  applications.  They  are  not  only  protective  and 
antiseptic,  but  the  carbolic  acid  which  they  contain  pro- 
duces anaesthesia  of  the  affected  surface ;  that  is,  it  dimin- 
ishes the  sensibility  of  the  skin.  "  Carron-oil,''  composed 
of  equal  parts  of  linseed  or  olive  oil  and  lime-water,  is 
regarded  as  a  very  valuable  remedy.  The  cosmoline, 
vaseline,  carron-oil,  etc.,  should  be  spread  on  a  piece  of 
lint,  soft  linen,  or  muslin,  and  laid  on  the  burn.  The 
part  should  then  be  enveloped  in  cotton  batting,  or  two  or 
three  folds  of  flannel,  or  some  other  soft  material  which 
will  properly  protect  the  part ;  the  dressing  should  then 
be  retained  by  a  bandage.  During  the  examination  of 
severe  burns  of  any  degree,  and  also  while  the  applica- 
tion of  dressings  is  being  made,  great  caution  should  be 
observed  that  the  part  is  not  unduly  exposed  to  the  air ; 
serious  results  have  followed  the  careless  exposure  of  a 
burn  of  this  character.  Such  danger  can  be  avoided  by 
examining  or  dressing  one  part  of  the  burn  at  a  time. 

In  BURNS  OF  THE  SECOND  DEGREE  the  blisters  require 
special  treatment.  If  attached  to  the  burn,  the  clothing 
should  never  be  forcibly  removed,  but  carefully  cut  off 
with  scissors  as  close  to  the  burn  as  possible.  The  small 
pieces  adhering  to  the  skin  may  be  washed  away  with 
warm  w^ater,  or  softened  with  oil,  and  detached  later.  If 
the  blisters  are  large,  they  should  be  pricked  at  their  low- 
est part,  and  the  contents  allowed  to  escape,  or  should  be 


142  PROMPT   AID   TO   THE    INJURED. 

absorbed  with  clean  blotting-paper.  The  oily  substances 
i»ecommended  for  burns  of  the  first  degree  may  then  be 
used,  or  the  part  carefully  washed  with  an  antiseptic  so- 
lution, and  dry  antiseptic  gauze  applied.  The  dressings 
should  not  be  disturbed  of tener  than  every  two  days  unless 
they  become  moist  or  offensive. 

In  BURNS  OF  THE  THIRD  DEGREE,  where  there  is  destruc- 
tion of  the  tissues  and  more  or  less  sloughing,  antiseptic 
applications  (carbolized  vaseline,  oil,  etc.)  are  particularly 
indicated ;  offensive  discharges  should  not  be  allowed  to 
accumulate,  but  must  be  removed  by  warm  antiseptic  solu- 
tions, and  fresh  dressings  applied.  The  removal  of  the 
slough  or  dead  tissue  may  be  hastened  in  the  manner  al- 
ready described.     (See  Compresses  and  Poultices.) 

In  burns  caused  by  acids  (generally  sulphuric,  nitric, and 
muriatic),  water  should  not  be  applied,  for,  when  combined 
with  an  acid,  an  elevation  of  temperature  of  the  mixed 
fluids  immediately  follows.  The  proper  remedy  would  be 
the  application  of  an  alkaline  powder,  bicarbonate  of  soda, 
magnesia,  chalk,  or  lime  ;  the  latter  may  be  scraped  from 
whitewashed  walls.  These  agents  neutralize  the  acid,  and 
should  be  left  on  the  sm'face  but  a  few  moments  and  then 
washed  off. 

If  an  acid  is  splashed  into  the  eye,  lime-water  or  a  so- 
lution of  soda  or  magnesia  should  be  applied  at  once,  also 
a  few  drops  (three  or  four)  of  a  four-per-cent  solution  of 
cocaine ;  the  latter  relieves  the  excessive  pain.  Burns  of 
the  mouth  and  tlu'oat  from  the  same  cause  (acids)  are  also 
to  be  treated  by  the  free  use  of  the  alkalies  already  men- 
tioned.    (See  Poisons.) 

Burns  produced  by  caustic  alkalies  (caustic  soda,  potash, 
lime,  ammonia,  also  quicklime  and  lye)  should  be  treated 
by  the  application  of  acid  solutions,  as  diluted  vinegar, 
lemon  juice,  hard  cider,  etc.  Nitric,  muriatic,  sulphuric, 
and  acetic  acid  may  be  used,  but  only  when  ivell  diluted^ 
and  with  great  circumspection. 

After  the  acid  or  alkali  causing  the  burn  has  been  neu- 


BURNS,   SCALDS,   AND   FliOST-BITE.  ]\i] 

tralized,  the  oily  substances  already  referred  to  should  be 
applied  as  in  ordinary  burns. 

Catching  Fire. — Some  of  the  severest  forms  of  burns 
follow  catching  fire  of  some  portion  of  the  wearing- 
apparel.  A  person  in  this  condition  should  at  once  be  en- 
veloped in  a  blanket,  coat,  mat,  piece  of  carpet,  or  what- 
ever may  be  at  hand  to  extinguish  the  flames,  or  she  (the 
victim  is  usually  a  woman)  should  be  rolled  over  and  over 
on  the  floor  to  smother  the  flames.  Water  must  be  freely 
used  and  the  clothing  carefully  examined  to  ascertain  if 
the  fire  has  been  entirely  extinguished.  The  burned  sur- 
faces should  then  receive  the  proper  attention,  according 
to  their  degree  and  intensity. 

In  some  burns  continuous  fanning  will  relieve  the 
pain — submersion  in  water  kept  warm  will  also  in  some 
instances  have  a  soothing  effect,  particularly  as  air  is  ex- 
cluded. 

Consiltutional  Treatment  of  Burns. — Shock,  which  is 
always  present  in  severe  burns,  requires  the  administra- 
tion of  stimulants.  Pain  is  more  constant  and  intense  in 
burns  than  in  any  other  form  of  injury,  and  requires  sed- 
atives, which  should  be  administered  by  the  medical  at- 
tendant. Later  on,  the  appearances  of  inflammation  and 
other  complications  are  to  be  carefully  watched  for. 

Scalds  are  injuries  produced  by  the  application  of 
moist  heat,  as  boiling  water,  steam,  etc.  Children  com- 
monly suffer  from  these  injuries  as  the  result  of  pulling 
over  kettles  containing  hot  coffee,  tea,  or  water.  Scalds 
should  be  treated  as  burns  of  the  first  and  second  degrees. 

Certain  positions  assumed  by  the  patient  to  relieve 
pain  in  burns,  particularly  about  the  arm  pit,  fingers  or 
toes,  if  not  looked  after  may  cause  webbing  or  limited 
motion  on  recovery. 

FROST-BITE. 

Prolonged  exposure  of  the  body  to  a  very  low  temper- 
ature results  in  a  general  or  local  loss  of  vitalitv.     While 


144  PROMPT  AID  TO  THE  INJURED. 

the  air  is  still,  or  snow  is  falling,  it  is  favorable  to  the  one 
•exposed.  Snow  is  a  bad  conductor  of  heat,  and  offers  con- 
siderable protection;  but  when  the  wind  is  blowing,  the 
warm  air  close  to  the  surface  of  the  body  is  rapidly  re- 
moved, and  the  destructive  effect  of  the  cold  is  consider- 
ably increased.  An  exposure  of  one  or  two  hours,  inade- 
quately clad,  to  intense  cold  may  be  followed  by  a  fatal 
result.  Those  who  are  thus  unfortunately  situated  are 
soon  overcome  by  an  irresistible  sense  of  drowsiness  and 
desire  to  sleep ;  to  yield  to  the  inclination  is  usually  fatal. 
This  disposition  to  stupor  is  due  to  the  great  diminution 
in  the  blood-supply  to  the  surface,  and  consequent  conges- 
tion of  internal  organs.  In  this  condition  the  brain  is 
unable  to  properly  perform  its  function  and  drowsiness 
follows. 

In  those  who  are  frozen,  the  limbs  become  stiff  and  the 
skin  white;  the  latter  is  preceded  by  a  blue  or  purplish 
tint,  which  may  still  be  apparent  at  the  tips  of  the  nose, 
toes,  and  fingers.  This  change  in  color  denotes  that  the 
circulation  and  nourishment  of  the  surface  of  the  body 
are  profoundly  interfered  with,  and  is  commonly  followed 
by  excessive  reaction  and  inflammation  or  gangrene. 

Treatment. — A  person  who  is  frozen  should  never  be 
taken  to  a  warm  room,  or  have  warmth  applied  to  the 
body.  An  abrupt  change  in  temperature  would  be  almost 
necessarily  fatal.  The  temperature  must  be  gradually 
raised.  Consequently,  the  patient  should  be  carried  to  a 
cool  apartment,  the  clothing  removed,  and  the  body 
rubbed  with  snow  or  cold  water.  After  a  short  time,  par- 
ticularly if  consciousness  returns  and  the  limbs  lose  their 
rigidity,  the  use  of  a  piece  of  flannel,  or,  still  better,  the 
hand,  can  be  substituted  for  the  cold  application.  The 
continuous  rubbing  may  now  be  discontinued,  and  oc- 
casional friction  resorted  to.  These  measures  must  be 
pursued  very  gently,  as  rough  manipulation  might  destroy 
the  skin.  It  may  be  necessary  to  resort  to  artificial  res- 
piration in  extreme  cases. 


BURNS,   SCALDS,   AND   FROST-HITE.  ]  45 

Stimulants  carefully  administered  are  indicated  if  the 
patient  can  swallow;  until  this  is  possible,  they  should  be 
given  by  the  rectum,  or  ammonia  or  smelling-salts  by  in- 
halation ;  nourishment  in  the  form  of  beef -tea  or  milk  may 
be  given  as  soon  as  the  patient  can  take  it.  The  surface 
of  the  body  should  be  carefully  protected,  but  not  sub- 
jected to  heat,  as  some  time  must  elapse  before  the  circu- 
lation of  the  affected  part  regains  its  equilibrium.  If  por- 
tions of  the  surface  subsequently  become  dark  bluish  or 
mottled,  gangrene  has  commenced.  If  the  latter  takes 
place  dry  and  not  moist  dressing  should  be  employed,  as 
moisture  encourages  decomposition. 


11 


CHAPTEE    Xin. 

UNCONSOIOUSNESS,  SHOCK,  AXD  SYNCOPE, 

UNCO^'^scIOUSXESS  is  associated  with  a  number  of  differ- 
ent affections,  and  in  order  to  intelligently  treat  this  con- 
dition it  is  necessary  that  one  should  he  fsfmiliar  with  the 
different  causes  producing  it ;  among  which  are  apoplexy, 
opium -poisoning,  alcoholism,  syncope,  concussion  and 
compression  of  the  brain,  and  ei)ilepsy.  This  is  very  im- 
portant, as  the  remedies  suitable  for  one  would  be  unfit 
for  another  :  for  instance,  the  unconsciousness  due  to 
syncope  demands  stimulants,  which,  if  administered  in 
apoplexy,  might  cause  or  hasten  a  fatal  result.  Ignorance 
of  this  subject  has  often  been  responsible  for  the  humili- 
ating and  seinous  mistake  of  regarding  a  case  of  apoplexy 
as  intoxication. 

As  the  result  of  complications,  it  sometimes  happens 
that  the  cause  of  the  unconsciousness  may  not  for  the 
moment  be  apparent ;  however,  a  careful  examination  for 
signs  indicating  the  different  affections  giving  rise  to  this 
condition  will  generally  clear  up  existing  doubts".  During 
this  period  of  uncertainty  the  xoatient  should  be  placed 
in  the  recumbent  position,  with  the  head  slightly  ele- 
vated or  depressed,  according  to  the  appearance  of  the 
face,  whether  congested  or  pale.  The  clothing  about  the 
neck  and  body  should  be  loosened,  and  fresh  au'  freely 
supplied.  Stimulants  should  be  used  with  caution,  and 
only  when  positively  indicated.  Artificial  respiration  may 
be  resorted  to  in  extreme  cases. 


SHOCK.  147 

SHOCK— COLLAPSE. 

Shock  is  a  condition  in  which  there  is  a  more  or  less 
(Uniinished  energy  of  the  heart  and  circulation,  and  is  the 
result  of  a  severe  impression  made  upon  the  nervous  sys- 
tem, produced  by  either  a  physical  injury,  or  a  mental 
onotion.  The  majorit}^  of  cases  met  with  are  the  result  of 
extensive  burns  or  other  grave  injuries,  particularly  those 
produced  by  gunshot  wounds  and  railway  accidents,  which 
are  generally  associated  with  great  laceration  and  crush- 
ing of  the  tissues,  and  mental  excitement.  Severe  cases  of 
shock  may  be  produced  by  fright  alone.  Shock  may  be  of 
a  veiy  mild  character,  as  the  result  of  a  trifling  injury  or 
fright,  the  symptoms  being  hardly  noticeable,  of  short  du- 
ration, and  demanding  no  treatment ;  or,  it  may  assume  a 
form  which  is  rapidly  fatal. 

The  symptoms  of  shock  depend  upon  the  severity  of 
the  cause  ;  in  some,  where  the  injury  is  slight,  they  may 
be  hardly  apparent,  or,  only  a  pale  face  and  a  weak  and 
rapid  pulse,  a  slight  nausea,  and  a  general  sense  of  prostra- 
tion may  be  evinced.  The  form  that  fully  illustrates  a  case 
of  severe  shock  would  be  that  following  a  serious  railway 
injury,  and  can  hardly  be  mistaken.  There  is  no  other 
condition  which  so  closely  resembles  death.  The  extreme 
pallor  and  coldness  of  the  skin  are  startling  ;  the  surface 
of  the  body  is  covered  with  moisture  ;  large  beads  of  sweat 
cover  the  forehead  ;  the  pulse  at  the  wrist  may  be  lost, 
or  if  perceptible,  is  weak,  rapid,  and  irregular ;  the  features 
are  shriveled,  particularly  about  the  nose,  which  appears 
pinched;  the  eyes  are  lusterless,  sunken  deeply  in  the  sock- 
ets, and  turned  upward,  the  pupils  being  generally  dilated; 
tha  fingers  and  nails  are  of  a  bluish  color.  The  patient  is 
conscious,  but  dazed  and  flighty,  can  not  realize  his  condi- 
tion, and  apparently  only  appreciates  loud  and  repeated 
questions ;  articulation  is  difficult,  although  there  is  no  pa- 
ralysis present.  The  sensibility  to  pain  may  be  so  blunted 
that  an  operation  can  be  performed  without  the  cogni- 


148  PROMPT   AID   TO  THE  INJURED. 

zance  of  the  patient.  As  a  result  of  the  depression  of  the 
circulation,  the  heat  of  the  body  is  diminished,  the  tem- 
perature in  some  cases  being  below  the  normal  register. 
The  respu'ations  are  sighing  in  character  and  irregular, 
and  the  patient  is  restless.  These  symptoms  may  continue 
for  a  ie^v  minutes  or  a  number  of  hours,  and  often  end 
in  death. 

In  cases  which  end  favorably,  there  appear,  usually 
within  an  hour  or  so,  symptoms  denoting  an  increase  in 
the  strength  of  the  heart  and  circulation  ;  this  change  is 
known  as  reaction,  and  generally  indicates,  so  far  as  the 
shock  is  concerned,  a  happy  termination.  When  reaction 
occurs,  the  color  and  warmth  gradually  return  to  the  skin, 
the  eyes  are  brighter  and  the  mind  clearer ;  the  pulse  be- 
comes stronger,  and  the  symptoms  indicate  an  approach  to 
the  normal  condition.  Vomiting  is  regarded  as  a  favor- 
able symptom,  and  generally  denotes  reaction. 

Reaction,  however,  does  not  always  insure  the  safety  of 
the  patient,  as  it  may  be  interrupted  suddenly  by  haemor- 
rhage or  failure  of  the  heart  and  death ;  or,  in  injuries  about 
the  head,  the  reaction  may  be  so  intense  as  to  go  beyond 
the  normal  activity  of  the  circulation,  and  produce  seri- 
ous cerebral  diseases,  such  as  congestion  or  inflammation 
of  the  brain ;  for  this  reason  the  patient  should  be  care- 
fully watched,  and  excessive  reaction  obviated  by  posi- 
tion, quiet,  cold  applications  to  the  head,  and  wannth  to 
the  extremities. 

Cases  of  shock  from  severe  injuries,  associated  with 
complete  unconsciousness,  almost  always  prove  fatal. 

Treatment. — It  will  only  be  necessary  to  refer  to  the 
condition  indicated  by  shock  to  clearly  understand  the 
means  necessary  to  bring  about  reaction;  consequently, 
whatever  can  safely  be  used  to  stimulate  the  heart  and 
circulation  constitutes  the  proper  treatment.  As  an  illus- 
tration, we  will  suppose  that  a  man  has  been  injured  by  a 
railway  accident  and  is  found  in  a  condition  of  shock. 
Whoever  is  to  attend  to  the  case  should  at  once  loosen 


SHOCK.  149 

tlie  clothing",  and  make  a  rapid  examination  to  ascertain 
whether  severe  haemorrhage  exists  (which  fortunately  is 
not  common  in  shock,  owing  to  the  feebleness  of  the  circu- 
lation), or  whether  some  other  symptom  may  be  present  de- 
manding innnediate  attention,  which  being  promptly  alle- 
viated, the  patient  should  be  carefully  conveyed  to  a  place 
near  by,  more  suitable  for  the  subsequent  treatment.  While 
being  removed  the  head  should  be  as  low  as  or  somewhat 
lower  than  the  body,  or  the  extremities  may  be  slightly  ele- 
vated, so  as  to  favor  the  flow  of  blood  toward  the  brain.  If 
possible,  four  persons  should  be  selected  to  carry  the  pa- 
tient, one  for  each  extremity  and  the  contiguous  portions 
of  the  body.  If  one  or  more  of  the  bones  of  an  extremity 
have  been  broken,  a  temporary  splint  ought  to  be  applied 
to  prevent  any  movement  of  the  fragments  of  bone  at  the 
seat  of  fracture  during  transportation,  and  should  be  at- 
tended to  as  rapidly  as  possible,  and  before  the  man  is 
lifted  from  the  ground.  Arriving  at  the  place  selected,  the 
clothing  of  the  patient  should  be  removed  carefully,  or  cut 
away,  if  necessary,  rather  than  have  too  much  delay.  He 
should  then  be  placed  in  a  warm  bed,  his  head  being  still 
kept  low. 

The  treatment  now  consists  in  applying  warmth  to  the 
surface  of  the  body,  and  internal  stimulation.  The  first 
indication  can  be  met  by  surrounding  the  patient  with 
bottles  containing  hot  water,  placing  them  about  the 
arms  and  legs,  inside  the  thighs,  and  under  the  arm-pits 
and  about  the  body,  but  not  about  the  head,  as  the  heat 
might  favor  a  subsequent  congestion  when  reaction  oc- 
curs; hot  bricks,  stones,  plates,  etc.,  will  also  answer  the 
purpose,  dry  heat  being  the  essential  elemejit.  It  must  be  re- 
membered that  the  sensibility  of  the  patient  is  blunted,  and 
that  the  bottles  or  bricks  may  be  so  hot  as  to  bum  the  skin 
and  not  inflict  any  pain.  A  hot  plate,  enveloped  in  a  towel, 
may  be  placed  over  the  region  of  the  heart,  and,  when  un- 
usual vomiting  occurs,  mustard  plasters  applied  over  the 
stomach.     Friction  is  a  method  of  some  value  in  exciting 


150  PROMPT  AID   TO  THE  INJURED. 

the  circulation,  and  should  be  resorted  to  when  heat  can 
not  be  supplied  as  indicated  above.  The  second  indication 
— the  use  of  internal  stimulation— is  of  course  governed  by 
the  condition  of  the  patient.  If  able  to  swallow,  he  should 
be  given  about  two  teaspoonfuls  of  whisky  or  brandy,  with 
a  small  amount  of  hot  water,  or,  still  better,  hot  milk ;  this 
may  be  repeated  every  ten  or  fifteen  minutes,  until  four  or 
five  doses  have  been  taken,  or  reaction  becomes  apparent. 
When  the  latter  occurs,  the  stimulant  should  be  dimin- 
ished or  discontinued.  There  are  cases  where  a  greater 
amount  of  liquor  may  be  required,  but  it  should  be  given 
with  caution,  as  too  much  may  produce  undue  vomiting 
and  favor  excessive  reaction.  If  a  number  of  large  doses  of 
a  stimulant  have  been  given  with  no  effect,  it  is  evident  that 
the  stomach  is  unable  to  absorb  the  fluid,  and  its  further 
administration  by  the  mouth  would  be  useless.  A  large 
number  of  persons  suffering  from  shock  are  unable  to 
swallow,  as  the  result  of  extreme  prostration ;  this  should 
be  carefully  ascertained  before  giving  anything  by  the 
mouth,  as  strangulation  may  ensue,  the  fluid  entering  the 
larynx.  In  such  cases  a  tablespoonful  or  more  of  liquor 
in  half  a  cupful  of  warm  milk  or  water  can  be  intro- 
duced into  the  rectum  (lower  bowel)  by  a  syringe,  and 
may  be  repeated  about  every  fifteen  or  twenty  minutes ; 
also  pint  injections  of  water  as  hot  as  can  be  borne  by 
the  hand. 

The  value  of  the  liquors  depends  upon  the  percentage  of 
alcohol  they  contain,  which  in  brandy  and  whiskj^  is  about 
forty  to  fifty  per  cent,  and  consequently  more  than  in  wines, 
which  contain  but  from  fifteen  to  thirty-five  per  cent.  One 
half  the  amount  of  alcohol  diluted  as  above  would  therefore 
be  a  substitute  for  the  liquors.  Beer  and  ale,  containing 
only  two  or  three  per  cent  of  alcohol,  would  be  worse  than 
useless,  simply  filling  up  the  stomach,  with  no  satisfactory 
results.  A  small  amount  of  spirits  of  ammonia  or  ether, 
or  about  four  or  five  drops  of  nitrite  of  amyl,  on  the  hand 
or  a  handkerchief,  and  placed  near  the  patient's  nose,  has 
a  decided  stimulant  effect.     Warm  turpentine  rubbed  up 


SYNCOPE.  151 

and  clown  the  spine  can  be  used  with  benefit,  if  it  does  not 
interfere  with  the  treatment  already  begun. 

The  usual  and  most  effective  method  of  introducing 
stimulants  into  the  system,  now  employed  by  physicians, 
is  by  the  hypodermic  method,  which  consists  of  injecting 
under  the  skin,  with  the  hypodermic  syringe,  stimulants- 
brandy,  whisky,  or  ammonia-water  ;  the  amount  so  in- 
jected being  generally  from  twenty  drops  to  a  teaspoonful 
of  the  undiluted  stimulant,  and  is  repeated  as  often  as  is 
indicated  by  the  condition  of  the  patient. 

Artificial  respiration  may  be  resorted  to  in  desperate 
cases,  but  it  is  of  doubtful  value.  When  reaction  has  taken 
place,  the  stimulants  are  gradually  diminished,  and  some 
form  of  nutriment  may,  if  required,  be  administered;  it 
must  be  given  in  small  doses,  and  of  such  a  character  as  to 
be  readily  absorbed.  Warm  beef -tea  or  milk,  or  an  occa- 
sional sip  of  kumyss,  will  be  sufficient  for  the  time  being. 

SYNCOPE— FAINTING. 

Syncope  is  a  condition  of  suspended  animation  associ- 
ated with  a  gTeat  diminution  of  blood  in  the  brain  and 
unconsciousness,  and  caused  by  sudden  enfeeblement  of 
the  heart's  action. 

Syncope  may  be  the  result  of  disease  of  the  heart, 
haemorrhage,  pain,  excessive  emotion,  as  grief,  fear,  and 
joy;  tight  lacing,  certain  drugs,  indigestion,  hunger,  ex- 
haustion, and  the  hot  and  vitiated  air  of  public  assemblies, 
are  also  exciting  causes  of  this  condition.  Before  the  stage 
of  unconsciousness,  the  person  affected  experiences  a  weak 
and  sinking  feeling,  associated  with  dizziness,  dimness  of 
vision,  roaring  in  the  ears.  The  face  and  extremities  be- 
come pale,  cold,  and  clammy. 

The  stage  of  unconsciousness  may  last  a  few  seconds  or 
a  number  of  hours ;  hoAvever,  it  usually  extends  over  a 
period  of  but  a  few  minutes,  during  which  time  the  pulse 
is  either  very  weak  or  lost,  and  the  respirations  are  shal- 
low and  sometimes  apparently  cease. 


152  PKOMPT  AID  TO  THE  INJURED. 

Fainting  is  of  common  occurrence  and  not  usually 
fatal. 

Treatment. — The  treatment  is  ver^^  simple,  and  consists 
in  stimulating  the  heart  and  circulation,  and  increasing 
the  amount  of  blood  in  the  brain.  The  j^atient  should  be 
laid  down,  with  the  head  considerably  lower  tlian  the  body, 
to  favor  the  flow  of  blood  toward  the  brain.  Fresh  air  is 
one  of  the  essential  elements  in  the  treatment  of  fainting. 
All  tight  clothing,  as  collars,  corsets,  skirts,  or  trousers, 
should  be  at  once  loosened,  and  stimulation  in  some  form 
begun.  Smelling-salts,  ammonia,  and  other  stimulants 
may  be  poured  on  a  handkerchief  or  the  palm  of  the  hand 
and  given  by  inhalation,  care  being  taken  that  none  is 
dropped  into  the  eyes,  and  that  the  remedy  is  not  held  too 
close  to  the  nose  or  mouth,  otherwise  violent  irritation  of 
the  air-passages  may  follow.  The  head  and  face  may  be 
bathed  with  an  alcoholic  solution,  as  camphor,  bay-rum, 
cologne,  or  whisky,  or  friction  can  be  applied  to  the  limbs 
and  over  the  heart.  No  attempt  should  be  made  to  ad- 
minister stimulants  by  the  mouth  unless  the  patient  is 
able  to  swallow. 

The  means  just  described  are  usually  sufficient  to  bring 
about  reaction.  In  some  cases,  however,  it  will  be  neces- 
sary to  resort  to  more  active  measures,  such  as  the  intro- 
duction of  stimulants  into  the  rectum  or  lower  bowel,  in 
the  manner  described  in  shock,  or  the  inhalation  of  nitrite 
of  amyl — about  five  drops  on  the  palm  of  the  hand  or  on 
a  handkerchief — held  to  the  nose  of  the  patient,  the  appli- 
cation of  mustard  over  the  heart,  or  it  may  be  necessary 
to  employ  artificial  respiration. 

A  person  after  recovery  from  an  attack  of  syncope 
should  be  kept  quiet  until  the  action  of  the  heart  and  cir- 
culation is  properly  strengthened. 

Syncope  and  shock  are  similar,  and  may  be  the  result 
of  the  same  cause  ;  however,  in  syncope  the  patient  is  un- 
conscious,  while  in  shock  he  is  more  or  less  conscious. 
Shock  usually  follows  a  severe  injury,  whereas  fainting 


SYNCOPE.  153 

may  follow  a  very  trivial  cause.  Syncope  differs  from 
apoplexy  in  the  following"  manner :  In  syncope,  the  face 
is  pale,  the  pulse  weak,  and  the  respiration  shallow,  and 
the  attack  is  generally  of  short  duration ;  while  in  apo- 
plexy the  face  is  usually  congested,  the  pulse  is  slow,  full, 
and  sometimes  irreg-ular,  the  arteries  in  the  neck  throb 
violently,  and  the  breathing  is  noisy  and  labored  or 
snoring  (stertorous),  and  paralysis  exists  on  one  side  of 
the  body. 


CHAPTEE   XIV. 

CONCUSSION  AND    COMPRESSION   OF  THE  BRAIN— APOPLEXY 
—INTOXICATION-EPILEPSY— HYSTERIA— HEAT-STROKE. 

Concussion  of  the  brain  is  a  term  applied  to  a  shaking* 
up  or  jarring  of  this  organ.  More  or  less  contusion  of  the 
cerebral  tissue  probably  occurs  in  severe  cases.  This  form 
of  injury  is  the  result  of  a  fall  or  blow  upon  the  head, 
or  the  shock  may  be  transmitted  upward  through  the 
spinal  column,  as  in  jumping  from  a  height,  etc.  The  in- 
jured person  may  only  be  stunned  or  dizzy  for  a  moment, 
with  no  loss  of  consciousness ;  the  face  is  usually  pale, 
and  more  or  less  weakness  and  trembling  of  the  limbs 
are  present.  These  transient  symptoms  are  generally  fol- 
lowed by  a  rapid  restoration  to  the  normal  condition  ; 
although  in  apparently  mild  cases  serious  cerebral  dis- 
turbance may  subsequently  occur — usually  within  a  week. 
In  severe  cases  there  is  partial  stupor  and  a  feeble  pulse ; 
the  pupils  may  be  contracted  or  dilated,  but  generally 
react  to  light ;  the  surface  of  the  body  is  cold,  and  i^est- 
lessness  and  vomiting  are  usually  present.  As  a  rule, 
the  breathing  is  natural.  In  grave  cases  the  patient 
is  in  the  condition  of  shock,  which  has  already  been  de- 
scribed. There  is  one  point  connected  with  the  shock 
following  concussion  of  the  brain  which  must  be  empha- 
sized, viz.,  that  the  reaction  is  usually  excessive,  being 
more  pronounced  than  in  shock  following  injuries  of 
other  parts  of  the  body,  and  often  terminates  in  inflam- 
mation of  the  brain. 

Treatment. — In  mild  cases  the  treatment  consists  in 
keeping  the  patient  quiet,  with  a  cooling  application  to  the 
head.  The  more  serious  cases  of  concussion  of  the  brain 
which  assume  the  form  of  shock  should  receive  the  treat- 
ment appropriate  to  the  latter  affection,  particular  atten- 
tion being  paid  to  the  extreme  reaction  that  may  occur. 


APOPLEXY.  155 

For  this  reason,  internal  stimulants  should  not  be  given. 
Warmth  to  the  extremities,  and  cold  applied  to  the  head, 
are  also  indicated. 

Kest  and  quietude  must  be  insisted  upon  in  all  cases 
of  concussion  of  the  brain. 

COMPRESSION   OF   THE   BRAIN. 

Compression  of  the  brain  comniouly  follows  fracture 
of  the  skull,  a  portion  of  the  broken  bone  being  driven 
into  the  cerebral  tissue  and  causing  pressure.  The  lodg 
ment  of  a  bullet,  or  cerebral  haemorrhage,  may  also  pro- 
duce this  condition.  It  is  often  difficult  to  differentiate 
between  concussion  and  compression  of  the  brain.  How 
ever,  in  compression,  the  stupor  is  more  profound,  the 
pulse  is  slow,  the  pupils  are  dilated  and  do  not  respond  to 
light,  and  the  breathing  stertorous,  similar  to  that  in 
apoplexy.  There  is  more  or  less  paralysis  present,  and 
convulsions  may  occur. 

Treatment. — Aside  from  keeping  the  patient  quiet  and 
applying  cold  in  some  form  to  the  head,  and  preventing 
the  administration  of  stimulants,  very  little  can  be  done 
by  an  unprofessional  person,  and  the  case  should  be  placed 
in  the  hands  of  a  surgeon  as  early  as  possible.  If  a  wound 
is  present,  it  should  be  protected  by  an  antiseptic  compress. 

APOPLEXY— STROKE    OF   PARALYSIS. 

Apoplexy  is  a  sudden  loss  of  consciousness  associated 
with  paralysis,  and  generally  due  to  the  failure  of  a  certain 
portion  of  the  brain  to  perform  its  function,  as  the  result  of 
pressure  following  the  escape  of  blood  (haemorrhage)  from 
a  diseased  cerebral  vessel.  Embolism,  which  is  very  similar 
to  apoplexy  in  its  manifestations,  is  caused  by  the  plugging 
up  of  a  large  artery  within  the  skull,  which  is  followed 
by  a  loss  of  vitality  and  function  of  a  portion  of  the  brain. 

The  paralysis  is  confined  to  one  half  of  the  body  (hemi- 
plegia). For  example,  if  the  hipmorrhage  is  on  the  left 
side  of  the  brain,  the  muscles  of  the  corresponding  side  of 
the  face  and  of  the  right  arm  and  leg  are  rendered  power- 


156  PROMPT  AID   TO  THE  INJURED. 

less.  The  paralysis  may  sometimes  affect  the  opposite 
side  of  the  face.  The  paralysis  occurring  on  the  opposite 
side  of  the  body  from  the  seat  of  pressure  is  due  to  the 
crossing  of  the  nerves  already  referred  to  (see  Nerves). 

The  form  of  apoplexy  caused  by  cerebral  haemorrhage 
affects  persons  advanced  in  years.  A  jDerson  may  suffer 
from  a  number  of  attacks  in  quick  succession,  or  at  long 
intervals,  or  the  first  may  prove  fatal.  The  common  be- 
lief that  one  dies  during  the  third  attack  is  unfounded. 
Apoplexy  is  apt  to  occur  after  a  meal  or  during  sleep. 

Although  an  apoplectic  attack  may  be  gradual,  and 
preceded  by  pain  in  the  head,  nausea,  confusion  of  thought 
and  a  slight  convulsion,  it  is  more  commonly  abrupt,  and 
not  preceded  by  any  sign  or  symptom  which  indicates  its 
approach.  The  subject  usually  falls  to  the  ground  as 
though  struck  down,  although  in  some  cases  the  attack  is 
less  sudden,  and  preceded  by  a  sharp  outcry. 

If  unconsciousness  does  not  occur  immediately,  it  fol- 
lows in  a  very  short  time — within  a  few  minutes.  In  this 
condition  the  patient  can  not  be  aroused,  which  is  an  im- 
portant point  in  distinguishing  this  from  some  other  affec- 
tions. The  face  becomes  reddened  or  congested,  and  the 
pupils  are  usually  dilated,  but  not  always ;  one  may  be- 
dilated  and  the  other  remain  in  the  normal  condition  or 
contracted.  The  respirations  are  slow,  labored,  and  snor- 
ing (stertorous  breathing),  the  cheeks  being  puffed  out 
during  expiration.  The  pulse,  although  generally  slow, 
does  not  differ  very  much  from  that  of  health.  Convul- 
sions and  vomiting  may  occur. 

Apoplexy  is  often  mistaken  for  intoxication — a  very 
disagreeable  and  unfortunate  error.  It  may  also  be  mis- 
taken for  opium-poisoning  and  epilepsy. 

It  should  be  remembered  that  in  intoxication,  hemi- 
plegia does  not  exist ;  the  pulse  is  frequent,  and  the  alcoholic 
odor  of  the  breath  is  always  present  (this  may  sometimes 
be  present  in  apoplexy) ;  also  that  vomiting  is  common, 
and  the  subject  can  be  more  or  less  aroused  by  pinching, 
douching  with  cold  water,  etc. 


INTOXICATION.  157 

Inr  opium-poisouiiig  there  is  iui  absence  of  liemiplegia, 
the  respirations  are  very  slow,  sometimes  being  reduced 
to  four  or  five  during  the  minute.  The  face  is  pale  and 
the  pupils  are  uniformly  contracted. 

The  absence  of  hemiplegia,  the  convulsive  movements, 
and  foaming  at  the  mouth,  and  the  comparative  short  du- 
ration of  the  attack,  are  usually  sufficient  to  distinguish 
epilepsy  from  apoplexy. 

If  improvement  does  not  follow  an  attack  of  apoplexy 
within  ten  or  twelve  hours,  the  case  usually  terminates 
fatally. 

Treatment. — The  object  of  treatment  is  to  arrest  the 

further  escape  of  blood  within  the  skull ;  consequently  the 

head  should  be  slightly  elevated,  and  cracked  ice  or  some 

other  form  of  cold  applied.     The  clothing  about  the  neck 

and  waist  should  be  loosened.     Internal  stimulants,  which 

tend  to  increase  the  haemorrhage,  must  not  be  used.     If 

possible,  warmth  should  be  applied   to   the   extremities. 

The  further  treatment  must  be  indicated  by  the  medical 

attendant. 

INTOXICATION. 

Intoxication  is  a  condition  of  such  common  occurrence 
that  a  lengthened  description  would  be  unnecessary.  The 
important  element  in  the  consideration  of  this  subject  is 
to  impress  upon  the  reader  the  necessity  of  particularly 
distinguishing  this  condition  from  apoplexy,  and  has 
already  been  referred  to  in  the  article  on  the  latter  subject 
(see  Apoplexy).  If  any  doubt  exists,  the  patient  should 
be  laid  upon  his  back,  ^vith  the  head  slightly  elevated, 
and  all  constriction  about  the  neck  and  waist  removed, 
and  perfect  quietude  and  rest  maintained  until  the  arrival 
of  the  medical  attendant. 

Treatment.  —  The  treatment  of  intoxication  consists 
usually  of  rest  and  quiet.  Nature  being  generally  able  to 
effect  the  desired  result.  If  vomiting  does  not  take  place, 
mustard  may  be  given  to  produce  emesis  (vomiting).  In 
some  cases  it  may  be  necessary  to  apply  warmth  to  the 


158  PROMPT  AID  TO  THE  INJURED. 

extremities  and  over  the  heart,  also  ammonia  or  nitrite  of 
amyl  by  inhalation,  and  rectal  stimulation  (coffee,  etc.). 

EPILEPSY— EPILEPTIC  FITS- FALLING  SICKNESS. 

Epilepsy  is  an  affection  of  the  brain  which  at  variable 
intervals  gives  rise  to  an  attack  characterized  by  convul- 
sive movements  and  unconsciousness. 

Subjects  of  this  disease  are  usually  warned  of  the  ap- 
proach of  a  paroxysm  by  certain  sensations  which  imme- 
diately precede  the  convulsion;  the  premonitions,  how- 
ever, are  generally  of  very  short  duration.  The  attacks 
usually  occur  singly,  although  one  may  follow  another  in 
rapid  succession. 

The  person  affected  utters  a  sharp,  piercing  cry,  and 
falls  to  the  ground  in  an  unconscious  and  helpless  con- 
dition, and  is  thus  frequently  seriously  injured  about  the 
face.  This  is  followed  immediately  by  more  or  less  rigid- 
ity, and  a  few  moments  later  the  convulsive  movements 
commence.  The  eyes  are  usually  opened  and  turned  up- 
ward, the  pupils  being  dilated.  The  face  becomes  livid 
and  congested,  the  jaws  are  brought  together  with  consid- 
erable force,  and  the  tongue  is  very  commonly  badly 
wounded  by  the  teeth.  There  is  considerable  foaming  or 
frothing  at  the  mouth. 

The  paroxysm  lasts  but  a  few  minutes,  when  con- 
sciousness gradually  returns,  the  patient  being  in  a  stupid 
and  drowsy  condition  for  a  short  time  afterward. 

Malingerers  and  hysterical  subjects  who  endeavor  to 
simulate  epilepsy  do  not  bite  their  tongues,  and  usually 
select  a  convenient  place  in  which  to  fall. 

Treatment. — The  treatment  of  an  epileptic  attack  con- 
sists in  laying  the  patient  on  his  back,  loosening  the 
clothing,  particularly  about  the  neck,  and  preventing  in- 
jury to  the  tongue  by  placing  between  the  teeth  a  cork, 
piece  of  wood,  or  handkerchief-knot.  The  stupor  that 
follows  the  convulsion  requires  no  treatment,  unless  the 


IIVbTEKlA.  150 

patiei>t  is  quite  weak,  when  stimulants  may  be  very  cau- 
tiously given. 

It  must  not  be  forgotten  that  following  an  epileptic 
seizure  sometimes  a  temporary  mental  aberration  may  fol- 
low, therefore  the  person  affected  should  be  carefully 
watched  for  some  little  time  after  the  seizure. 

HYSTERIA— HYSTERICS— HYSTERICAL  ATTACK. 

Hysteria  is  a  functional  affection  of  the  mind  and 
nervous  system,  occurring  in  paroxysms,  usually  affecting 
females,  and  characterized  by  temporary  loss  of  will-power 
and  considerable  emotional  display  on  the  part  of  the  one 
affected,  who  laughs  and  sobs  immoderately,  without  any 
regard  to  the  surroundings. 

Hysteria  sometimes  assumes  a  form  which  may  be 
mistaken  for  syncope,  apoplexy,  or  epilepsy,  according  to 
the  manifestations  of  the  patient. 

Hysterical  subjects  should  not  be  treated  as  malinger- 
ers; the  perverted  condition  of  the  nervous  system  leads 
them  to  believe  that  the  illness  assumed  is  real.  One  un- 
accustomed to  observing  cases  of  hysteria  may  be  easily 
misled,  therefore  the  following  distinctive  characteristics 
should  be  remembered. 

A  case  of  hysteria  may  be  distinguished  from  syncope 
in  the  following  manner:  In  hysteria  the  extremities  and 
face  are  warm  instead  of  cold,  and  the  pulse  is  normal; 
and  when  an  effort  is  made  to  open  the  eyelids,  it  is  met 
with  considerable  opposition,  wdiich  does  not  occur  in  un- 
consciousness. In  the  hysteria  that  simulates  epilepsy 
the  tongue  is  not  injured,  and,  if  the  patient  falls,  a  suit- 
able place  is  selected  for  this  purpose,  in  order  to  avoid 
injury.  There  is  no  frothing  at  the  mouth  in  hysteria, 
unless  produced  by  soap  or  other  agents  held  in  the  mouth. 

Although  hysteria  may  be  associated  with  temporary 
paralysis  and  mistaken  for  apoplexy,  it  will  be  noticed 
that  the  facial  muscles   are  not   involved,   and  that  the 


160  PROMPT  AID  TO  THE   INJURED. 

paralysis  does  not  always  affect  one  side  of  the  body 
(hemiplegia),  and  there  is  no  stertorous  breathing  and 
flapping  of  the  cheeks,  which  are  so  prominent  in  apo- 
plexy. 

Treatment. — The  best  treatment  for  a  case  of  hysteria 
is  to  let  the  patient  alone.  To  sympathize  with  one  in 
this  condition  simply  prolongs  the  attack  and  can  do  no 
good.  Firmness  on  the  part  of  the  attendant,  with  an 
intimation  that  the  condition  is  fully  understood,  is  gen- 
erally all  that  is  necessary.  When  considerable  demon- 
stration is  made,  it  is  a  common  practice  to  douche  the 
patient  with  cold  water.  If  this  method  is  used,  it  should 
be  confined  to  the  face;  pouring  a  large  quantity  of  cold 
water  indiscriminately  over  a  weak  and  delicate  woman  is 
not  always  followed  by  the  most  desirable  results.  When 
it  is  suspected  that  unconsciousness  is  feigned  ammonia 
water  applied  to  the  nose  will  almost  always  have  the  de- 
sired effect. 

HEAT-STROKE— SUNSTROKE— INSOLATION— SUN-FEVER— 
HEAT-APOPLEXY. 

The  term  heat-strohe  is  now  used  to  denote  the  serious 
manifestations  which  sometimes  follow  exposure  to  in- 
tense heat.  This  condition  may  be  due  to  the  direct  rays 
of  the  sun,  or  to  a  high  temperature  caused  by  solar  or 
artificial  heat.  Those  who  are  employed  in  hot  and  close 
apartments,  where  the  air  is  impure,  as  in  mines  and  in 
the  fire-rooms  of  steamers,  are  particularly  liable  to  be 
affected  by  heat-stroke  from  artificial  heat. 

It  is  a  fact  worthy  of  notice  that  those  who  generally 
suffer  from  this  malady  are  either  addicted  to  the  use  of 
stimulants  or  are  in  a  weak  or  debilitated  condition. 

Locality  has  considerable  influence  in  causing  sun- 
stroke, the  vitiated  air  of  the  city  in  the  hot  summer 
months  being  particularly  favorable  to  it.  The  high  de- 
gree of  temperature  which  can  ordinarily  be  borne  by  the 
body  is  mainly  dependent  upon  the  proper  action  of  the 


HEAT-!STliOKE.  161 

skin;* the  large  amount  of  perspiration  being  rapidly 
evaporated,  cools  the  surface  and  indirectly  the  blood. 
Evaporation  takes  place  more  rapidly  when  the  air  is 
dry;  consequently,  heat-stroke  is  more  frequent  when  the 
air  is  moist.  The  heavy  woolen  shirts  worn  by  work- 
men in  hot  weather  are  cooler  than  those  made  of 
cotton,  because  the  former  increase  the  activity  of  the 
sweat-glands,  and  indirectly  diminish  the  temperature  of 
the  body. 

Heat-stroke  is  not  always  developed  abruptly,  nor  does 
it  generally  occur  at  the  beginning  of  a  heated  term,  but 
usually  after  the  hot  weather  has  been  persistent  for  two 
or  three  days.  There  are  certain  symptoms  which  indicate 
the  approach  of  this  affection  and  should  be  recognized  as 
a  warning,  viz. :  an  irritable  and  depressed  condition ; 
headache,  congestion  of  the  eyes,  and  flushing  of  the  face, 
and  also  a  dryness  of  the  skin  and  sometimes  nausea. 
Unless  the  person  affected  seeks  relief,  the  symptoms  just 
enumerated  are  followed  by  those  which  are  more  serious, 
as  delirium,  convulsions,  and  unconsciousness.  The  tem- 
perature of  the  body  sometimes  rises  to  a  great  height, 
108°-110°  (normal  temperature  being  98-iV°).  The  pupils 
are  generally  dilated,  although  sometimes  contracted. 
The  pulse  at  first  is  strong  and  rapid,  but  subsequently 
becomes  weak.  Death  may  occur  suddenly  in  consequence 
of  the  action  of  the  high  temperature  upon  the  nerve- 
centers,  or,  at  a  later  period,  as  the  result  of  exhaustion. 
Quite  a  large  percentage  of  those  who  recover  from  the 
immediate  effect  of  sunstroke  subsequently  suffer  from 
some  temporary  or  permanent  affection  of  the  nervous 
system. 

Those  who  have  been  overcome  by  the  heat  are  pecul- 
iarly susceptible  to  this  element  for  some  time  after- 
ward. 

Heat  exhaustion  is  a  mild  type  of  the  condition  just 
described  and  is  very  common.  The  symptoms  are  usually 
dizziness  or  faintness,  and  often  some  nausea  and  weak- 
13 


162  PROMPT  AID  TO  THE  INJURED. 

ness.  These  conditions,  however,  generally  respond  to 
simple  treatment. 

Treatment  of  Heat-Stroke. — There  are  two  impor- 
tant indications  for  treatment — reduction  of  temperature 
and  the  use  of  stimulants.  The  use  of  cold  is  regarded 
as  the  best  method  of  meeting  the  first  indication,  and 
the  manner  of  its  application  depends  upon  the  facilities 
at  hand.  The  patient  should  first  be  removed  to  a  cooler 
spot  if  possible,  or  at  least  vrhere  shade  can  be  secured, 
or,  if  a  person  succumbs  in  a  place  where  the  ventilation 
is  defective  (in  addition  to  the  heat),  he  should  be  carried 
to  the  fresh  air.  The  treatment  should  be  begun  at  once. 
Efforts  are  often  made  first  to  remove  the  patient  to  his 
home,  which  involves  the  loss  of  considerable  valuable 
time  and  may  still  further  exhaust  him.  The  clothing 
about  the  neck  and  body  must  be  either  loosened  or  re- 
moved. Cold  is  particularly  indicated  in  cases  where  there 
is  great  heat  of  the  body,  and  delirimn  and  convulsive 
movements  are  present.  This  means  of  reducing  the  tem- 
perature may  be  applied  in  the  shape  of  cracked  ice  about 
the  head  and  spine,  or  the  use  of  cold  water,  by  means  of 
a  sponge  or  by  pouring  it  from  a  sprinkling-pot,  or  the 
patient's  head  may  be  held  under  a  pump;  however,  the 
best  plan  is  to  remove  the  clothing  and  sponge  the  head 
and  body  with  cold  water  at  frequent  intervals.  If  the 
heat  of  the  body  is  very  great,  it  may  be  necessary  to  wrap 
the  patient  in  sheets  wet  with  cold  water.  The  sheets  are 
to  be  kept  wet  by  frequently  pouring  water  over  them 
while  on  the  body,  until  consciousness  returns  or  there  is 
an  evidence  of  marked  diminution  of  temperature.  After 
the  cold  has  been  discontinued,  should  serious  symp- 
toms, such  as  unconsciousness  or  the  previous  high  tem- 
perature, recur,  the  cold  application  should  again  be 
employed. 

If  there  is,  besides  the  great  heat,  evidence  of  serious 
depression,  stimulants  must  be  used  while  the  cold  is 
being  applied. 


HEAT-STROKE.  163 

There  are  some  cases  of  heat-stroke  where  stimulants 
alone  are  indicated,  as  when  the  signs  of  a  high  fever  are 
absent  and  great  depression  is  present.  In  these  cases,  in 
addition  to  the  use  of  internal  stimulation,  the  application 
of  mustard  over  the  heart  and  to  the  calves  of  the  legs  is 
indicated. 

The  treatment  of  heat  exhaustion  consists  in  rest, 
bathing  the  face  with  an  alcoholic  solution,  or  the  internal 
use  of  a  stimulant. 


CHAPTER    XV. 

ASPBYXIA  AND  DROWNlNa. 

ASPHYXIA— SUFFOCATION. 

Asphyxia  is  a  condition  of  unconsciousness  due  to  a 
great  diminution  of  oxygen  in  the  blood,  resulting  either 
from  an  obstruction  to  the  passage  of  air  to  the  lungs,  or 
to  the  presence  of  poisonous  gases  which  render  the  air 
unfit  for  respiration.  Among  the  numerous  causes  of  suf- 
focation are  drowning,  hanging,  and  obstruction  in  the 
respiratory  tract,  either  by  the  lodgment  of  foreign  bod- 
ies, or  by  certain  maladies  affecting  this  part,  as  croup. 
Asphyxia  also  follows  the  inhalation  of  the  fumes  of  char- 
coal or  coke,  and  the  carbonic-acid  gas  contained  in  empty 
wells,  caves,  beer- vats,  and  mines  ;  in  the  latter  situation 
it  is  known  as  "choke-damp."  Coal-gas  from  stoves,  and 
illuminating  and  sewer  gases,  are  frequent  causes  of  suf- 
focation. The  appearance  of  a  j)erson  suffering  from  as- 
phyxia is  well  marked.  The  face  is  of  a  dusky  or  purplish 
hue  (showing  deficient  oxygenation  of  the  blood),  and  swol- 
len. The  respirations  are  extremely  labored,  and  associ- 
ated with  convulsive  movements  and  delirium.  If  relief 
is  not  promptly  at  hand,  these  symptoms  are  rapidly  fol- 
lowed by  unconsciousness  and  death. 

Treatment. — The  treatment  consists  in  removing  the 
cause,  m  order  that  the  lungs  may  be  supplied  with  the 
proper  amount  of  pure  air,  and  restoring  the  different 
functions  to  their  normal  condition  by  stimulants  and 
artificial  respiration.     (See  Drowning.) 

Precautions. — In  rescuing  a  person  from  an  empty 


ASPHYXIA   AND   DROWNING.  1^5 

well,  care  should  be  taken  that  the  mouth  and  nose  of  the 
person  making-  the  descent  are  protected  by  holding-  against 
them  a  cloth  saturated  with  water,  or  vinegar  and  water. 
A  rope  should  also  be  tied  around  the  waist  of  the  rescuer, 
by  which  he  can  be  brought  rapidly  to  the  open  air. 
Matches  should  not  be  ignited  while  in  the  well,  nor  should 
any  artificial  light  be  carried  down ;  for,  while  carbonic 
acid  gas,  which  constitutes  the  bulk  of  poisonous  gases  in 
these  receptacles,  is  not  a  supporter  of  combustion,  other 
gases  may  be  present  which  are  ignitible,  and  a  serious  ex- 
plosion would  probably  follow.  Sewer-gases  are  often  in- 
flammable, and  illuminating  gases  always  so.  A  light 
should  never  be  taken  into  a  cellar  or  any  apartment 
where  gas  has  escaped,  until  the  room  has  been  thoroughly 
ventilated  by  open  windows  and  doors. 

It  is  often  necessary  to  enter  empty  w^ells  and  cess-pools 
in  order  to  examine  or  clean  them.  The  carbonic  acid  which 
they  contain,  and  which  is  heavier  than  air  and  consequently 
settles  to  the  bottom,  should  be  stirred  up  and  removed  pre- 
vious to  making  any  descent  for  examination.  This  may 
be  done  by  free  ventilation,  and  by  pouring  into  the  well 
large  quantities  of  water  or  lime-water,  or  by  lowering  and 
quickly  withdrawing-  an  opened  umbrella,  or  throwing 
down  lighted  papers  and  straw.  Should  the  latter  means  be 
used,  care  should  be  taken  not  to  remain  near  the  opening, 
as  gases  may  be  present  which  are  inflammable.  Discharg- 
ing a  gun  into  the  receptacle  may  be  employed  for  this  pur- 
pose. It  is  also  a  good  plan  to  lower  a  cat  or  a  dog  to  the 
bottom  of  the  excavation  and  allow  it  to  remain  there  for  a 
while  to  ascertain  if  the  air  at  that  point  is  respirable. 

DROWNING. 

The  asphyxia  or  suffocation  that  follows  submersion  is 
due  to  the  fact  that  air  is  preveiited  from  reaching  the 
lungs.  More  or  less  \vater  is  found  in  the  air-passages,  but 
not  in  such  quantities  as  is  generally  supposed.  In  some 
cases  very  little  if  any  water  reaches  these  organs,  on  ac- 


166  PROMPT  AID  TO   THE  INJURED. 

count  of  the  rapid  closure  of  the  epiglottis.  Water,  how- 
ever, enters  the  stomach,  and  considerable  is  found  mixed 
with  mucus  in  the  throat.  Death  is  usually  the  result 
of  suffocation.  However,  in  some  cases  it  may  be  due  to 
sudden  heart-failure  before  the  person  sinks.  When  such 
is  the  case  the  face  of  the  drowned  would  be  pale  and 
flabby,  and  very  little  water  and  mucus  would  be  found  in 
the  respiratory  tract.  There  is  a  better  chance  of  resusci- 
tating one  who  sinks  as  the  result  of  syncope  than  when 
suffocated,  as  the  demand  for  oxygen  in  the  former  is  less 
than  when  asphyxiated  by  submersion. 

Persons  who  are  submerged  for  four  or  five  minutes  or 
more  are  not  usually  restored  to  life;  although  numerous 
cases  are  recorded  where  resuscitation  was  effected  after 
an  interval  of  twenty  minutes.  In  such  cases  it  is  sup- 
posed that  syncope  occurred,  or,  on  account  of  the  exist- 
ing excitement,  an  error  was  made  in  calculating  the 
actual  time  of  submersion.  The  action  of  the  heart  usu- 
ally continues  some  little  time  after  respiration  ceases. 

Treatment. — This  consists  first  in  re-establishing  res- 
piration, then  stimulating  the  action  of  the  heart  and  cir- 
culation by  stimulants  and  warmth,  friction,  etc.  When 
a  person  has  been  under  water  but  a  few  moments,  simple 
means  may  restore  respiration,  and  should  be  tried. 

The  water,  sand,  and  mucus  should  first  be  quickly  re- 
moved from  mouth  and  nose,  and  the  attendant  should 
then  carry  his  finger  to  the  back  or  base  of  the  patient's 
tongue,  which  must  be  pulled  forward,  thus  enabling  wa- 
ter and  mucus  in  the  throat  and  respiratory  tract  to  es- 
cape, and  also  to  favor  the  entrance  of  air  into  the  lungs; 
while  this  is  being  done  the  patient  should  be  turned  on 
his  side  (left,  if  possible),  face  down,  to  favor  the  escape 
of  water  from  the  stomach  and  air  passages.  He  should 
then  again  be  turned  on  his  back,  while  the  hands  of  the 
attendant  are  placed  on  the  belly  or  abdomen  and  pressure 
directed  upward  and  inward  toward  the  diaphragm.  This 
movement  tends  to  stimulate  respiration  and  should  be  re- 


DROWNING.  167 

peated  two  or  three  times  at  intervals  of  two  or  three  sec- 
onds. The  mouth  in  the  mean  time  should  be  kept  open 
by  a  cork  or  piece  of  wood,  or  a  knot  tied  in  a  handker- 
chief, etc.,  in  order  that  the  passage  of  air  to  the  lungs 
should  not  be  interfered  with.  Smelling-salts,  ammonia, 
or  two  or  three  drops  of  nitrite  of  aniyl,  may  be  admin- 
istered by  inhalation,  or  the  nose  may  be  tickled  with  a 
feather  or  straw.  When  breathing  commences  and  con- 
sciousness returns,  the  patient  should  be  carefully  divested 
of  all  wet  clothing  (if  necessary,  the  clothing  should  be 
cut  to  avoid  delay),  well  rubbed,  and  wrapped  in  warm 
covering,  and  stimulants  given  in  the  manner  already  de- 
scribed.    (Shock.) 

If  the  simple  measures  just  enumerated  are  productive 
of  no  good  result  after  a  short  trial,  artificial  respiration 
should  be  at  once  resorted  to.  Three  methods  of  artificial 
respiration  are  accepted  as  being  particularly  efficient,  viz., 
Sylvester  s,  Howard's,  and  Hall's.  The  first  (Sylvester's) 
is  generally  regarded  as  being  the  best.  The  methods  of 
Sylvester  and  Howard  may  be  performed  by  one  person. 

Before  artificial  respiration  is  begun,  the  patient  should 
be  stripped  to  the  waist,  and  the  clothing  around  the  latter 
part  should  be  loosened  so  that  the  necessary  manipula- 
tions of  the  chest  may  not  be  interfered  with.  Further- 
more, it  should  be  remembered  in  artificial  respiration  not 
to  exceed  the  normal  respiratory  rhythm  of  about  eighteen 
respirations  per  minute.     This  is  often  overlooked. 

Sylvester's  Method. — The  water  and  mucus  are  sup- 
posed to  have  been  removed  from  the  interior  of  the  body 
by  the  means  above  described.  The  patient  is  to  be  placed  on 
his  back,  with  a  roll  made  of  a  coat  or  a  shawl  under  the 
shoulders;  the  tongue  should  then  be  drawn  forward  and 
retained  by  a  handkerchief  which  is  placed  across  the  ex- 
tended organ  and  carried  under  the  chin,  then  crossed  and 
tied  at  the  back  of  the  neck.  An  elastic  band  or  small 
rubber  tube  or  a  suspender  may  be  substituted  for  the 
same  purpose.     If  no  other  means  can  be  made  avail- 


168 


PROMPT   AID   TO   THE   INJURED. 


able,  a  liat-  or  scarf-pin  may  be  thrust  vertically  through 
the  end  of  the  tongue  without  injury  to  this  organ.  The 
attendant  should  kneel  at  the  head  and  grasp  the  elbows 
of  the  patient  and  draw  them  upward  until  the  hands  are 


Fig.  80.— Sylvester's  method.    First  movement  (inspiration). 

carried  above  the  head  and  kept  in  this  position  until  one, 
two,  three,  can  be  slowly  counted  (Fig.  80).  This  move- 
ment elevates  the  ribs,  expands  the  chest,  and  creates  a 
vacuum  in  the  lungs  into  which  the  air  rushes,  or,  in  other 
words,  the  movement  produces  inspiration.  The  elbows 
are  then  slowly  carried  downward,  placed  by  the  side,  and 


Fig.  81.— Sylvester's  method.    Second  movement  (expiration) 


pressed  inward  against  the  chest,  thereby  diminishing  the 
size  of  the  latter  and  producing  expiration  (Fig.  81).  These 
movements  should  be  repeated  about  fifteen  times  during 


DROWNING. 


IGD 


each  minute  for  at  least  two  hours,  provided  no  signs  of 
animation  present  themselves. 

Howard's  method  is  divided  into  two  parts.  Part 
first  consists  in  removing  the  water,  etc.,  from  the  respira- 
tory tract  and  stomach,  and  is  as  follows: 

The  patient  should  be  i)laced  face  downward,  with  a 
pillow  or  roll  of  clothing"  under  the  pit  of  the  stomach,  the 
head  resting  on  the  forearm,  which  keeps  the  mouth  from 
the  ground  and  renders  traction  on  the  tongue  unnecessary. 
The  attendant,  standing  over  the  drowned  person,  should 
then  place  his  left  hand  on  the  lower  and  back  part  of  the 
left  side  of  the  chest,  while  the  right  hand  is  laid  on  the 


Fig.  82.— Ho\vard"s  method.     Part  first. 

spinal  column  about  on  a  line  or  a  little  above  the  left 
hand ;  firm  pressure  is  then  made  by  the  operator  throw- 
ing the  weight  of  his  body  forward  on  his  hands ;  this  is 
to  be  continued  while  one,  two,  three,  are  counted  (slowly), 
and  ended  with  a  push  w^hich  helps  to  raise  the  operator 
to  an  upright  position  and  forcibly  expel  the  fluid.  These 
movements  should  be  repeated  tw^o  or  three  times  if  fluid 
continues  to  flow  from  the  mouth  (Fig.  82). 


170 


PROMPT   AID  TO  THE  INJURED. 


Part  Second  :  Artificial  Respiration. — Tlie  patient 
should  now  be  turned  on  his  back,  face  directly  upward, 
with  the  roll  placed  under  the  shoulders ;  it  should  be  made 
thick  enough  to  allow  the  head  and  neck  to  be  fully  thrown 
back.  The  hands  of  the  patient  should  be  carried  above 
his  head  and  tied  with  a  handkerchief,  suspenders,  etc. 
The  attendant  should  then  kneel  astride  the  patient's  hips 
and  place  the  palm  of  his  open  hands  upon  the  lower 
part  of  the  patient's  chest  with  the  thumbs  at  the  lower 
border  of  the  breast-bone,  the  JQjigers  being  applied  to  the 
spaces  between  the  ribs,  the  little  finger  being  laid  along 
the  lower  border  of  the  ribs,  in  front.  The  hands  are  then 
pressed  slowly  and  firmly  upward  and  inward  toward  the 
diaphragm  or  midrrff,  with  the  body  of  the  operator 
thrown  forward  until  his  face  is  nearly  in  contact  with 
that  of  the  patient.  A  sharp  push  is  then  made  upon  the 
chest,  which  helps  to  bring  the  operator  to  an  upright  posi- 
tion. A  rest  of  two  or  three  seconds  should  then  follow, 
and  the  movement  repeated.  These  procedures  should  be 
continued  for  about  two  hours  before  being  abandoned, 
unless  the  patient  is  sooner  restored  (Fig.  83). 


Fig.  83.— Howard's  method.     Part  second. 


Hall's  Method. — The  drowned  person  should  be 
placed  face  downward,  the  head  resting  on  his  forearm 
with  a  roll  or  pillow  placed  under  the  chest;  he  should 


DROWNING. 


171 


then  be  turned  on  his  side,  an  assistant  supporting  the 
head  and  keeping  the  mouth  open ;  after  an  interval  of  two 
or  three  seconds,  the  patient  should  again  be  placed  face 
downward  and  allowed  to  remain  in  this  position  the  same 
length  of  time.  This  operation  should  be  repeated  fifteen 
or  sixteen  times  each  minute,  and  continued  (unless  the 
patient  recovers)  for  at  least  two  hours  (Figs.  84,  85). 


Fig.  84.— Hall's  method.     First  position. 

If,  after  using  one  of  the  above  methods,  evidence  of 
recovery  appears,  such  as  an  occasional  gasp  or  muscular 
movement,  the  efforts  to  produce  artificial  respiration  must 
not  be  discontinued,  but  kept  up  until  respiration  is  fully 
established.     All  wet  clothing  should  then  be  removed, 


Fig.  85.— Hall's  method.    Second  position. 

the  patient  rubbed  dry,  and  if  possible  placed  in  bed  where 
warmth  and  stimulants  can  be  properly  administered.  A 
small  amount  of  nourishment,  in  the  form  of  warm  milk 
or  beef -tea,  should  be  given,  and  the  patient  kept  quiet  for 
two  or  three  days. 


CHAPTEE   XVI. 

MEDICATION. 

In  poisoning  or  in  other  emergencies  where  the  ser- 
vices of  a  physician  are  urgently  needed  but  can  not  be 
secured,  relief  is  often  afforded,  or  life  saved,  by  the 
prompt  action  of  some  one  present  who  can  intelligently 
administer  medicinal  agents.  Therefore  even  a  general 
knowledge  of  this  subject  may  at  any  time  prove  of  great 
value. 

Medicine  is  given  by  the  mouth,  under  the  skin,  or  by 
the  rectum,  the  first  being  the  method  usually  employed, 
although  the  action  of  a  drug  is  much  more  rapid  and 
effective  when  given  beneath  the  skin  (hypodermically) ; 
besides,  in  some  instances,  it  is  impossible  or  impracticable 
to  administer  remedies  by  the  mouth,  for  instance,  when 
the  patient  is  unconscious  or  when  doubt  exists  as  to  the 
ability  of  the  stomach  to  absorb  them.  Under  these  cir- 
cumstances the  use  of  the  hypodermic  syringe  is  partic- 
ularly indicated,  although  it  must  not  be  forgotten  that 
this  procedure  is  not  without  an  element  of  danger  if  pre- 
cautions are  not  taken  to  prevent  it.  Cleanliness  should 
be  observed  to  prevent  contamination,  as  infection  may 
be  introduced  into  the  system  in  this  manner;  besides, 
abscesses  at  the  seat  of  injection  sometimes  occur  even 
when  care  is  used.  Whatever  agent  is' employed  should 
be  thoroughly  dissolved  in  fresh  water  received  in  a  clean 
glass.  After  the  solution  is  slowly  drawn  into  the  syringe 
the  piston  should  be  forced  forward  until  a  drop  or  two 
of  the  solution  escapes  from  the  point  of  the  needle,  indi- 
cating that  the  air  has  been  expelled  from  the  cylinder. 


MEDICATION.  IJl] 

A  comirion  and  favorite  site  for  hypodermic  injection  is 
on  the  anterior  part  of  the  arm,  between  the  bend  of  tlie 
elbow  and  shoulder,  over  the  biceps  muscle.  However, 
the  injection  may  be  given  in  the  legs,  back,  or  abdomen. 
The  needle  should  not  be  introduced  at  a  right  angle  with 
the  surface,  but  almost  parallel  with  it,  being  pushed 
through  a  portion  of  integument  raised  by  the  thumb  and 
forefinger  of  the  opposite  hand. 

The  active  principle  or  alkaloid  of  a  drug  should  be 
selected  for  hypodermic  administration,  inasmuch  as  mi- 
nute doses  will  produce  the  constitutional  effect;  besides, 
its  action  is  more  rapid  and  effective.  For  example, 
morphine  is  an  active  principle,  or  alkaloid  of  opium, 
atropine  of  belladonna,  and  strychnine  of  nux-vomica. 
As  little  water  as  possible  should  be  used  in  making  the 
solution.  Stimulants  such  as  brandy  and  whisky  in  full 
strength  are  frequently  used  hy  podermically  in  collapse,  etc. 

A  medicine  given  hypodermically  should  be  from  one 
third  to  one  half  less  than  vvhen  given  by  the  mouth. 
For  instance,  when  introduced  in  this  way  one  eighth  of 
a  grain  of  morphine  will  cause  about  the  same  effect  as 
one  fourth  of  a  grain  given  by  the  mouth.  ' 

The  following  medicinal  agents  are  commonly  found 
in  mixtures  given  to  allay  pain  or  coughing,  or  to  pi'oduce 
sleep,  or  in  the  form  of  tonics,  and  therefore  frequently 
cause  poisoning  by  improper  administration,  etc.  The 
doses  given  are  for  an  adult  and  for  administration  by 
the  mouth.  For  children  the  amount  should  be  dimin- 
ished according  to  age : 

Opium : 

Tincture  (laudanum),  dose,  10  to  20  drops. 
Camphorated  tincture  (paregoric),  dose,  2  to  3  teaspoonfuls. 
Morphine,  the  important  active  principle  or  alkaloid,  dose, 
i  to  ^  gr. 

Belladonna : 

Tincture,  dose,  5  to  15  drops. 

Atropine,  active  principle  or  alkaloid,  dose,  y^  to  /j  gr. 


174  PROMPT   AID   TO   THE   INJURED. 

Nux-vomica : 

Tincture,  dose,  5  to  10  drops. 

Strychnine,  active  principle  or  alkaloid,  dose  ^  to  3^  gr. 

Arsenic  : 

Fowler's  solution,  dose  2  to  10  drops. 
Arsenious  acid,  dose,  gV  to  -^  gr. 

Autipyrin,  antifebrin,  and  other  similar  agents,  known 
as  coal-tar  products,  are  frequently  used  without  the  ad- 
vice of  a  physician  ;  it  must  be  remembered  that  compara- 
tively small  doses  not  infrequently  cause  serious  depres- 
sion of  the  heart. 

Bromide  of  soda,  or  bromide  of  potash,  dose  ten  to 
thirty  grains,  or  even  in  larger  doses.  Bromide  prepara- 
tions are  fi^equeotly  used  to  allay  nervousness,  produce 
sleep,  etc.,  and  may  be  regarded  as  comparatively  safe, 
as  enormous  doses  have  been  taken  without  a  fatal  result. 

Chloral  (hydrate  of  chloral),  dose,  five  to  ten  grains ; 
larger  doses  are  commonly  taken  to  cause  sleep,  but  it  is 
not  unattended  with  danger. 

In  the  treatment  of  poisoning  (see  next  chapter)  opium, 
belladonna,  and  nux  vomica  are  frequently  referred  to  as 
antidotes ;  it  must  be  understood  that  this  refers  to  the 
most  available  and  effective  preparations  of  the  drug. 
For  instance,  if  opium  is  mentioned,  it  is  understood  that 
it  can  be  given  in  the  form  of  the  powder  (dose,  one  grain — 
not  commonly  used),  the  tincture,  camphorated  tincture, 
or  the  most  important  active  principle,  morphine,  the 
physiological  effect  of  all  being  practically  the  same.  The 
condition  of  the  patient  should  rather  decide  which  prep- 
aration shall  be  given,  provided  a  choice  can  be  made. 
However,  in  poisoning,  or  in  intense  pain,  the  use  of  the 
active  principle  or  alkaloid  of  the  drug,  and  the  hypoder- 
mic method  of  administration,  are  manifestly  preferable. 

In  the  use  of  certain  drugs,  such  as  opium  and  bella- 
donna, etc.,  it  must  be  understood  that  a  cumulative  effect 
may  be  produced,  and  therefore,  when  they  are  used  as  an 


MEDICATION.  175 

antidote  in  poisoning  or  to  allay  pain,  the  dose  should  not 
be  repeated  more  than  once,  after  an  interv^al  of  lialf  an 
hour  or  an  hour,  and  then  not  given  again  for  a  much 
longer  period,  six  to  eight  hours,  unless  so  advised  by  a 
physician.  This  should  be  particularly  observed  when 
atropine  is  used  for  opium  poisoning  or  vice  versa. 

The  use  of  the  rectum  for  the  administration  of  drugs 
and  nourishment  is  to  be  considered  when  other  means 
are  not  available  or  practicable.  Whatever  is  given  in 
this  way  should  be  well  diluted  (about  a  cupful  at  each 
injection).  The  solution  should  be  warmed  and  as  bland 
as  possible.  When  medicine  is  given  in  this  manner,  it 
should  be  at  least  one  third  more  than  when  taken  by  the 
mouth.  If  time  permits,  medicine  may  be  administered 
by  the  rectum  in  the  form  of  suppositories,  which  are 
little  cone-  or  cartridge-shaped  bodies  prepared  by  drug- 
gists, composed  of  cocoa  butter,  containing  the  medicine. 
These,  if  introduced  sufficiently  far  up,  rapidly  melt  and 
are  absorbed.  Solutions  containing  medicine  or  nourish- 
ment in  the  form  of  tepid  milk,  or  both  together,  may 
be  introduced  into  the  rectum  by  a  common  Davidson  or 
rectal  syringe ;  care  should  be  taken  that  the  air  in  the 
syringe  is  expelled  before  the  nozzle  is  introduced. 


CHAPTEK    XVII. 

POISOm  AND  FOISONINa. 

Certain  agents  whicli  are  invaluable  in  the  treatment 
of  the  sick  and  injured  become  deadly  poisons  when  im- 
properly used.  This  may  be  the  result  either  of  accidents, 
eiTors  in  administration,  or  attempts  at  self-desti'uction. 

Poisons  may  be  divided  into  narcotics  and  irritants. 
Some  of  the  irritants  are  exceedingly  destructive  to  the 
tissues  with  which  they  come  in  contact,  and  are  known 
as  corrosive  poisons. 

Narcotics  are  employed  in  the  practice  of  medicine  to 
produce  a  soothing  effect  or  sleep.  When  these  di'ugs 
are  taken  in  poisonous  doses,  they  are  followed  by  symp- 
toms which  in  a  general  way  are  common  to  all  of  this 
class,  and  by  which  they  can  be  recognized  in  cases  of 
poisoning,  viz.,  delirium,  stujDor,  insensibility,  and  sterto- 
rous breathing.  Narcotics  cause  very  little,  if  any,  local 
irritation. 

IiTitants  are  used  medicinally  both  for  a  constitutional 
and  local  effect.  Theu'  poisonous  action  is  particularly 
noticeable  by  the  local  m'itation  they  produce.  Great 
destruction  of  the  tissues  with  which  they  come  in  contact 
follows  the  use  of  the  corrosives.  This  is  markedlj^  ap- 
parent about  the  lips,  mouth,  and  throat.  Intense  abdomi- 
nal pain,  associated  with  vomiting  and  purging,  and  also 
shock,  are  more  or  less  constant. 

Treatment  of  Poisoning. — The  treatment  of  poison- 
ing is  both  local  and  constitutional. 

The  local  treatment  consists  in  preventing  the  further 


POISONS   Ai\D   POISOXING.  177 

absorption  and  irritating  elfect  of  the  poison  by  remov- 
ing it  from  the  stomach  by  the  use  of  emetics  and  the 
stomach-pump.  Remedies  are  also  used  which  in  a 
measure  render  the  operation  of  the  poison  liarmless  (an- 
tidotes). 

T]u>  constitutional  treatment  is  directed  toward  an- 
tagonizing the  action  of  the  poison,  and  stimulating  the 
patient. 

Agents  which  directly  counteract  the  local  and  consti- 
tutional effect  of  a  poison  are  known  as  antidotes :  for  ex- 
ample, when  an  acid  is  taken  in  a  poisonous  dose,  an  alkali, 
such  as  soda,  is  given  as  the  antidote;  or,  w^hen  opium  is 
the  poison  introduced,  belladonna  is  administered  as  one 
of  the  physiological  antidotes.  These  examples  demon- 
strate local  and  constitutional  antidotes. 

Local  Treatment. — Emetics. — Under  this  heading 
may  be  included  the  introduction  of  the  forefinger  or  a 
feather  into  the  throat,  and  by  passing  either  backward  as 
far  as  possible  can  be  employed  to  induce  vomiting  (eme- 
sis).  This  means  may  also  be  used  to  stimulate  the  action 
of  emetics  which  have  been  given  internally. 

Mustard. — One  tablespoonful  added  to  half  a  pint  of 
tepid  water.  Mustard  is  a  stimulant  emetic,  and  very  valu- 
able in  narcotic  poisoning. 

Chloride  of  Sodiiini  (common  salt). — Two  tablespoon- 
fuls  added  to  half  a  pint  of  tepid  water.  Not  very  certain 
as  an  emetic,  but  generally  on  hand. 

Alum. — Tablespoonful  in  half  a  pint  of  tepid  water. 
Rather  a  feeble  emetic. 

Sulphate  of  Zinc  (white  vitriol).— Twenty  to  thu^ty 
grains  in  half  a  glass  of  water.  Very  efficient  and  safe. 
One  of  the  best  emetics. 

Ipecac. — Thirty  grains  of  the  powder  or  two  table- 
spoonfuls  of  the  wine  or  sirup  of  ipecac ;  the  latter  prepa- 
ration is  apt  to  be  found  in  the  house. 

Carbonate  of  Ammonia. — Thirty  grains  in  half  a  glass 

of  water. 

13 


178  PROMPT   AID   TO   THE  INJURED. 

Sulphate  of  Copper  (blue  vitriol,  blue-stone). — Five  to 
ten  g-rains  in  half  a  glass  of  water. 

The  dose  recommended  of  each  of  the  above  emetics  is 
for  adults,  the  amount  should  be  proportionately  small  for 
children. 

The  contents  of  the  stomach  may  be  removed  by  si- 
phonage.  This  method  is  effective,  and  can  be  carried  out 
without  much  trouble,  and  is  performed  as  follows :  One 
end  of  a  small  rubber  tube  about  six  feet  long,  after  being 
oiled,  is  passed  into  the  stomach.  This  procedure  requires 
considerable  care,  as  the  tube  may  be  introduced  into  the 
air-passage  by  mistake,  instead  of  into  the  oesophagus ;  for 
this  reason  the  tongue  should  be  depressed  and  the  end  of 
the  tube  carried  backward  as  far  as  possible  and  then  down- 
ward. After  this  has  been  accomplished,  the  end  project- 
ing from  the  mouth  is  raised  and  a  funnel  attached,  through 
which  tepid  water  (about  two  or  three  pints)  should  be 
poured  into  the  stomach.  The  upper  end  of  the  tube 
(still  raised)  should  be  pinched  between  the  thumb  and 
finger,  and  in  this  condition  lowered  below  the  level  of 
the  stomach.  When  the  thumb  and  finger  are  removed, 
the  water  held  in  the  tube  acts  as  a  siphon,  and  the  con- 
tents of  the  stomach  are  withdrawn,  provided  the  poison- 
ing does  not  occur  soon  after  a  meal.  This  operation  may 
be  repeated  a  number  of  times,  until  the  poison  has  been 
removed.  It  is  always  best,  particularly  in  cases  of  sui- 
cide, to  place  a  cork,  or,  still  better,  a  spool  of  thread,  as  a 
gag  between  the  teeth,  to  prevent  the  tube  from  being  bit- 
ten in  two. 

The  use  of  a  stomach- tube  is  not  indicated  when  the 
poisoning  is  due  to  corrosives^  as  the  mucous  membrane 
is  greatly  swollen,  and  the  introduction  of  the  tube  is 
productive  of  gi'eat  pain  and  danger  of  laceration  of  the 
soft  tissues.  The  ordinary  fountain  syringe,  which  is 
found  in  almost  every  house,  is  an  excellent  instrument 
for  washing  out  the  stomach.  The  rubber  or  metal  end 
being  cut  off,  the  tube  can  be  introduced.  The  attached 
fountain  makes  the  use  of  a  funnel  unnecessary. 


POISONS   AND   POISONING.  179 

Constitutional  Treatment.— Tlie  constitutional  anti- 
dotes will  be  referred  to  with  tlie  special  poisons.  Stimu- 
lants are  indicated  to  overcome  the  depressing  action  of 
the  different  poisons,  particularly  the  narcotics,  and  may 
be  administered  by  the  mouth  (if  the  patient  can  swallow), 
provided  the  poisoning  is  not  due  to  corrosives^  or  by 
the  rectum  (lower  bowel),  by  inhalation,  or  by  hypo- 
dermic injection.  The  stimulants  administered  are  those 
ordinarily  used,  and  in  addition  strong  coffee  ;  the  latter 
is  of  great  value  in  narcotic  poisoning,  and  it  may  be 
given  in  the  same  manner  as  other  stimulants,  either  by 
the  mouth  or  rectum.  Alcoholic  stimulants  should  not 
be  given  in  opium  poisoning.  When  stimulants  are  given 
by  the  rectum,  the  amount  should  be  considerably  larger 
than  when  given  by  the  mouth,  and  they  should  be  diluted 
with  sufficient  warm  water  or  milk  to  make  a  cupful. 
Ammonia  and  nitrite  of  amyl  can  be  given  by  inhala- 
tion ;  they  should  always  be  administered  by  dropping  a 
sufficient  amount  on  a  handkerchief  or  the  palm  of  the 
hand.  The  bottle  should  never  be  held  to  the  nose,  as  the 
contents  might  be  spilled  into  the  mouth  or  nasal  cavity. 
Stimulants  should  be  given  by  inhalation  with  great  cau- 
tion, where  corrosive  poisons  have  been  taken,  as  they 
are  liable  to  irritate  still  more  the  inflamed  membrane. 
Nitrite  of  amyl,  which  is  given  by  inhalation,  is  a  power- 
ful heart  stimulant,  but  should  be  used  with  care  and  in 
small  amounts — three  to  five  drops.  This  remedy  is  now 
obtained  in  small  glass  capsules,  which  contain  about 
five  drops,  and  are  broken  when  the  nitrite  of  amyl  is 
needed.  Strychnine,  particularly  by  hypodermic  admin- 
istration, is  a  valuable  stimulant. 

The  following  list  of  narcotics  and  irritants  comprises 
those  which  are  commonly  the  cause  of  poisoning. 

NARCOTICS. 

Aconite.— (Monk's-hood,  wolfs-bane.)  The  tincture 
has  the  appearance  of  sherry  wine,  for  which  it  has  been 


180  PROMPT   AID   TO   THE  INJURED. 

mistaken.  Aconite  is  commonly  found  in  fever-mixtures, 
neuralgia  "cures,"  liniments  and  ointments,  and  is  exceed- 
ingly poisonous. 

Symptoms. — Great  prostration ;  tingling  of  the  lips, 
mouth  and  throat,  and  extremities — the  latter  become 
numb ;  slow  and  weak  pulse  ;  shallow  respiration  ;  the 
mind  is  generally  clear ;  convulsions  may  sometimes  occur. 

Treatment. — Emetics ;  free  use  of  stimulants  ;  warmth 
to  extremities  ;  twenty  drops  of  tincture  of  belladonna,  re- 
peated (once)  in  half  an  hour ;  mustard  over  heart  and 
calves  of  legs  ;  artificial  respiration. 

Alcohol. — Acute  poisoning  is  very  uncommon.  A 
large  amount  is  sometimes  taken  for  a  wager,  or  by  one 
unaccustomed  to  its  use. 

Symptoms.— i^QQ  Intoxication.) 

Treatment. — Evacuate  stomach  if  possible.  Keep  the 
patient  aroused  by  pinching,  slapping  with  wet  towel,  or 
hot  and  cold  douches  to  head  and  spine ;  coffee  in  large 
amount  by  stomach  or  rectum  ;  inhalation  of  ammonia, 
and  artificial  respiration  ;  strychnine. 

Belladonna. — (Deadly  night-shade.)  Contained  in 
cough-mixtures,  etc.,  liniments,  ointments,  and  plasters. 
Atropine,  the  active  principle  of  belladonna,  is  commonly 
found  in  eye  medicaments.  Poisoning  sometimes  follows 
the  use  of  an  external  application  containing  either  bella- 
donna or  atropine,  it  being  absorbed  through  the  unbroken 
skin. 

>S'?/?7ipfoms.— Headache ;  intense  dryness  of  mucous 
membrane  of  mouth,  throat,  and  nasal  cavity  ;  inability  to 
swallow  ;  eyes  brilliant  (belladonna  is  often  used  for  this 
purpose) ;  pupils  dilated ;  face  usually  flushed ;  delirium 
and  stupor,  or  convulsions.     Pulse  accelerated. 

Treafmenf.  —  (Belladonna  and  atropine.)  Emetics; 
opium,  repeated  (once)  in  half  an  hour;  stimulants; 
warmth  to  extremities  ;  artificial  respiration. 

Camphor.— Usually  taken  in  the  form  of  a  tincture 
(spirits),  or  the  gum. 


POISONS  AND   POISONING.  Jgl 

Symptoms.— ChsLvacieristic  odor ;  surface  of  body  cold 
and  clammy ;  disturbances  of  vision ;  noise  in  ears ;  de- 
lirium and  convulsions. 

Treatment. — Emetics;  stimulants;  warmth  to  extremi- 
ties ;  hot  and  cold  douches. 

Hydrate  of  Chloral.— (Chloral.)  Odor  similar  to 
bananas  or  pears.  Chloral  is  often  an  ingredient  in  sleep- 
ing- potions,  cough  mixture,  and  liniments. 

Symptoms. — Face  congested  ;  weak  pulse  ;  labored  res- 
pirations, stertorous  breathing;  stupor  and  unconscious- 
ness, sometimes  convulsions. 

Treatment. — Stimulants,  including  strychnine ;  warmth 
to  extremities,  coffee  by  rectum  ;  mustard  over  heart  and 
calves  of  legs  ;  artificial  respiration.  An  emetic  may  be 
given,  if  the  patient  is  seen  immediately  after  a  poisonous 
dose  has  been  taken. 

Chloroform.— When  poisoning  is  caused  by  inhala- 
tion, the  patient's  tongue  should  be  drawn  forward  and 
artificial  respiration  performed  ;  hot  and  cold  douches ; 
also  friction ;  plenty  of  fresh  air ;  the  patient's  head 
should  be  low,  or  it  may  be  allowed  to  drop  down,  the 
body  being  elevated  by  carrying  the  legs  over  the  shoul- 
der of  the  attendant. 

When  poisoning  follows  the  internal  use  of  chloro- 
form, large  doses  of  bicarbonate  of  soda  in  water  should 
be  given  internally,  in  addition  to  other  means  of  resusci- 
tation. 

Digitalis.— (Purple  foxglove.)  Generally  given  for 
heart  maladies. 

Symptoms. — Purging  and  vomiting  ;  great  pain  in  ab- 
domen ;  face  pale  ;  pupils  dilated  ;  skin  cold  and  clannny  ; 
pulse  feeble  and  slow  ;  great  depression  ;  gasping  respira- 
tion ;  delirium,  and  convulsions. 

Treatmeyit. — Emetics  (only  in  case  one  large  dose  of 
digitalis  has  been  swallowed)  ;  about  twenty  grains  of 
tannin  in  solution,  or  white-oak  l)ark,  or  strong  tea,  re- 
peated ;  mustard,  especiall^^  ovei*  tlie  lieart,  and  the  calves 


182  PROMPT  AID   TO   THE   IXJURED. 

of  the  legs,  and  stimulants  internally.  The  patient  should 
be  kept  in  the  recumbent  position  for  some  time  after  the 
serious  symptoms  have  ceased. 

Fungi. — Poisonous  mushrooms. 

Symptoms.  —  Colic ;  vomiting-  and  purging  ;  dilated 
pupils  ;  extreme  muscular  weakness  ;  mental  excitement. 
Symptoms  usually  occur  within  an  hour. 

Treatment. — Emetics  ;  castor-oil ;  stimulants ;  heat. 
Belladonna,  repeated  once.  "It  is  always  dangerous  to 
warm  up  a  dish  containing  mushrooms."     (Murrel.) 

The  treatment  of  mushroom-poisoning  is  applicable  to 
poisoning  by  eating  mussels. 

Hydrocyanic  Acid. — (Prussic  acid.)  The  dilute  acid 
is  the  form  in  which  this  poison  is  generally  used,  and  is 
a  colorless  fluid.  Prussic  acid  is  one  of  the  deadliest 
poisons  known.  The  poisonous  symptoms  begin  almost 
immediately. 

Symptoms. — Great  and  sudden  prostration,  or  uncon- 
sciousness and  slow  pulse  ;  surface  cold  and  clammy  ;  pu- 
pils dilated ;  eyes  fixed ;  blueness  of  face,  locked  jaws ; 
gasping  respiration  and  convulsions.  Death  may  occur 
almost  immediately. 

Treatment. — Dilatory  treatment  is  of  no  avail  in  poi- 
soning by  this  agent;  whatever  is  to  be  done  must  be 
done  at  once :  no  time  should  be  lost  in  trying  to  give 
emetics,  or  use  the  stomach-pump ;  stimulants  should  be 
given  freely ;  flapping  with  wet  towel ;  hot  and  cold 
douches  ;  artificial  respiration.  In  poisoning  by  this  drug, 
stimulants  should  be  given  by  hypodermic  injection, 
particularly  strychnine  ;  brandy  or  whisky,  or  ammonia- 
water  (not  spirits),  introduced  into  the  calf  of  the  leg, 
and  repeated  in  five  minutes ;  inhalations  of  nitrite  of 
amyl. 

The  symptoms  of  poisoning  which  may  occur  after 
cyanide  of  potassium,  peach-pits,  and  bitter  almonds  have 
been  taken  internally  are  dependent  upon  the  presence  of 
prussic  acid,  and  should  be  treated  accordingly. 


POISONS   AND   POISONING.  183 

Opium. — The  preparations  generally  used  are  morphine 
(the  active  principle  of  opium),  tincture  of  opium  (lauda- 
num), camphorated  tincture  of  opium  (paregoric),  Mc- 
Munn's  elixir,  codeine,  and  narceine.  Opium  is  an  active 
ingredient  in  many  preparations,  particularly  sedative  and 
cough  mixtures,  soothing  syrups  for  children,  and  numer- 
ous patent  medicines. 

Symptoms. — Usually  begin  with  more  or  less  mental  ex- 
citement, followed  by  great  depression,  headache,  sensation 
of  weight  in  the  limbs,  an  irresistible  desire  to  sleep,  which 
soon  deepens  into  a  stupor ;  the  pupils  are  contracted  and 
the  respirations  are  greatly  diminished  in  number,  some- 
times to  four  or  five  a  minute,  and  the  skin  is  cold  and 
clammy  and  the  face  pale.    Convulsions  sometimes  occur. 

Treatment. — Emetics ;  cold  and  hot  douches  alternately 
to  head,  face,  and  spine  ;  flapping  with  wet  towel ;  strong 
coffee  by  mouth  or  rectum.  Wines  and  liquors  must  not 
he  given.  Belladonna  repeated  (once)  in  fifteen  minutes. 
Artificial  respiration  for  two  or  three  hours  ;  inhalation  of 
oxygen.  The  patient  should  be  carefully  watched  for 
some  time  after  the  dangerous  symptoms  have  subsided. 

IRRITANTS. 

Arsenic. — This  agent  is  used  medicinally,  generally 
in  the  form  of  Fowler's  solution  and  arsenious  acid  ;  it  is 
also  contained  in  rat-pastes,  fly  and  vermin  killers,  and  is 
employed  to  a  large  extent  in  the  arts,  for  coloring  flowers, 
wall-paper,  stuffing  birds,  etc.  Realgar  is  a  red,  and  Orpi- 
ment,  or  King's  yellow,  is  a  yellow  preparation  of  arsenic. 
Arsenite  of  copper  (Paris  green,  or  Scheele's  green)  is  com- 
monly taken  hj  suicides. 

Symptoms. — Intense  burning  pain  in  pit  of  stomach ; 
faintness  and  depression  ;  vomiting  and  purging  ;  vomited 
matter  streaked  with  blood ;  sensation  of  constriction  in 
throat.  Abdomen  tender  and  painful ;  skin  cold  and 
clammy.  If  Paris  green  has  been  taken,  the  green  color  is 
generally  apparent  about  the  mouth,  hands,  or  clothing. 


184  PROMPT  AID   TO   THE   INJURED. 

Treatment. — Emetics;  large  draughts  of  hot,  greasy 
Trater,  or  salt  and  water ;  dialyzed  or  tincture  of  iron  in 
solution ;  a  large  amount  of  magnesia  may  be  given ;  or 
lime  which  may  be  scraped  from  the  walls  or  ceiling, 
white  crayons,  tooth  powders,  etc,  ;  castor-oil ;  sweet-oil, 
or  equal  parts  of  sweet-oil  and  lime-water,  or  lime-water 
alone;  raw  eggs ;  milk:  stimulants  (well  diluted  if  given 
by  the  mouth),  preferably  by  hypodermic  administration  ; 
opium  to  allay  the  pain, 

Caxtharides. — (Spanish  fly.) 

Symptoms. — Burning  sensation  in  mouth  and  throat , 
violent  pain  and  soreness  in  abdomen ;  vomiting  and 
purging,  vomited  matter  containing  streaks  of  blood  ;  great 
irritation  of  urinary  organs  and  passage  of  bloody  urine  ; 
delirium  and  convulsions. 

Treatment. — ^Emetics,  raw  eggs,  milk,  opium.  Stimu- 
lants; heat;  poultices  over  abdomen. 

Copper,  Sulphate  of  (blue  vitriol,  blue-stone),  or 
subacetate  of  copper  (verdigris),  is  sometimes  the  cause  of 
poisoning,  although  copper-poisoning  is  more  frequently 
due  to  substances  which  have  been  cooked  in  copper  ves- 
sels, which  is  an  unsafe  method  of  preparing  food. 

Symptoms. — Vomiting  and  purging ;  griping  pain  in 
abdomen  ;  metallic  taste  in  mouth  :  great  thirst  and  weak- 
ness ;  labored  respirations  and  rapid  pulse ;  dimness  of 
vision ;  and  sometimes  convulsions. 

Treatment. — Emetics,  if  vomiting  has  not  occurred. 
Copious  draughts  of  warm  water ;  raw  eggs ;  milk  ;  stimu- 
lants ;  opium. 

Croton-Oil. — Has  been  mistaken  for  castor-oil. 

Symptoms. — Vomiting :  purging  ;  violent  pain  in  ab- 
domen ;  great  depression  ;  skin  cold  and  clammy. 

Treatment . — Emetics,  if  vomiting  has  not  occurred. 
Raw  eggs ;  stimulants ;  spirits  of  camphor,  ten  drops  in 
water  every  five  minutes  until  five  or  six  doses  have  been 
taken ;  opium  by  mouth,  or  ^  grain  of  morphine  hypo- 
dermically. 


POISONS   AND    POISONING.  185 

Iodine. — As  generally  used  is  in  the  form  of  the  tinct- 
ure— a  dark  reddish  fluid 

Sym2)toms.—Grea,i]oc£il  irritation  and  pain;  the  mu- 
cous membrane  of  the  mouth  is  discolored  yellow  ;  vomit- 
ing and  i)urgijiff,  the  vomited  matter  having  a  bluish  color, 
as  the  result  of  the  admixture  of  the  iodine  and  starchy 
matter  of  the  food  (iodide  of  starch).  Blue  color  also  no- 
ticed when  vomited  matters  come  in  contact  with  starched 
articles  of  clothing. 

Treatment. — Free  use  of  starch,  then  emetics,  raw  eggs, 
chalk,  magnesia,  and  stimulants. 

Strychnine. — (The  active  principle  of  nux- vomica). 

Symptoms. — An  irritable  condition  of  the  muscular 
system,  and  twitchings  and  discomfort,  soon  followed,  usu- 
ally within  less  than  an  hour,  by  severe  convulsions,  which 
occur  at  intervals  of  two  minutes  to  half  an  hour.  The 
contractions  of  the  powerful  muscles  of  the  back  cause  the 
body  to  assume  the  form  of  a  bow,  the  patient  resting  on 
the  head  and  heels  (opisthotonos) ;  great  pain  is  present 
as  the  result  of  the  intense  muscular  contraction.  The 
mind  is  usually  clear.  The  respu'atory  muscles  are  promi- 
nently involved  in  this  affection,  and  death  by  asphyxia, 
as  the  result  of  rigidity  of  these  muscles,  may  follow,  or 
death  may  occur  later,  as  the  result  of  exhaustion. 

Strychnine-poisoning  can  only  be  mistaken  for  tetanus 
(locked- jaw).  The  distinction  is  to  be  made  as  follows  :  In 
strychnine-poisoning  the  attack  is  sudden  ;  there  is  gener- 
ally evidence  of  poison  ha\ang  been  taken,  and  no  injury 
has  been  received.  In  tetanus,  the  development  of  the  dis- 
ease is  more  gradual ;  no  poison  has  been  taken,  but  some 
form  of  injurj^  is  present.  In  strychnine-poisoning  the 
muscles  of  the  jaw  are  only  slightly  affected,  if  at  all,  but 
the  upper  extremities  are  always  involved ;  while  in  teta- 
nus, the  rigidity  of  the  muscles  of  the  jaws  (locked-jaw)  is 
the  first  and  prominent  S3''mptom,  and  continues  to  the  end, 
the  upiDcr  extremities  are  only  affected  in  the  severe  cases, 
and  then  only  slightly.    In  strychnine-poisoning,  the  dura- 


186  PROMPT   AID   TO   THE   IXJUP.ED. 

tion  of  the  attack  covers  but  a  few  hours,  while  in  tetanus 
a  number  of  days  may  be  involved. 

Treatment. — The  stomach-tube  can  only  be  used  if  the 
patient  is  seen  immediately  after  the  poison  is  taken,  as 
the  convulsive  movements  prevent  the  introduction  of 
the  tube.  Tannic  acid,  followed  by  an  emetic ;  then  large 
.  doses  of  bromide  of  sodium  or  potassium  (thirty  grains  in 
solution),  repeated  every  hour  until  three  or  four  doses 
have  been  taken,  together  with  nitrite  of  amyl ;  opium  ; 
artificial  respiration  may  also  be  called  for. 

Phosphorus. — Poisoning  frequently  occurs  as  the  re- 
sult of  sucking  or  swallowing  the  heads  of  matches.  This 
substance  is  also  contained  in  "  rat-pastes." 

Symptoms. — Vomiting  and  purging;  vomited  matter 
has  a  garlicky  odor,  and  is  luminous  in  the  dark.  Intense 
pain  in  abdomen. 

Treatment. — Emetics,  sulphate  of  copper  preferably; 
free  use  of  magnesia  ;  French  turpentine,  given  in  an  alco- 
holic or  alkaline  solution,  half  teaspoonful  every  half- 
hour,  until  a  number  of  doses  have  been  taken  (five  or 
six) ;  also  two  or  three  grains  of  sulphate  of  copper  as  an 
antidote  every  five  minutes  ;  white  of  egg ;  opium. 

Tartar  Emetic. — (Antimony,  or  Stibium.) 

Symjjtoms. — Vomiting  and  purging ;  vomited  matter 
contains  streaks  of  blood  ;  skin  cold  and  clammy  ;  collapse. 

Treatment. — Warm  water;  mixtures  of  tannic  acid; 
white-oak  bark  ;  also  strong  tea ;  stimulants,  and  warmth  ; 
opium. 

Zinc. — The  sulphate  or  chloride  is  generally  used.  The 
chloride  is  far  more  dangerous  and  corrosive. 

Symptoms. — Pain  and  vomiting,  with  great  depression, 
and,  if  the  chloride  has  been  taken,  the  mucous  membrane 
of  the  mouth  is  inflamed. 

Treatment. — Large  quantities  of  bicarbonate  of  soda 
(baking-powder)  or  carbonate  of  potash  in  solution  ;  milk; 
eggs ;  mixtures  of  tannic  acid  or  strong  tea,  or  oak-bark ; 
opium.  r^ 


POISONS  AND  POISONING.  187 


CORROSIVES. 


Acids. — Sulphuric  (oil  of  vitriol) ;  muriatic  (spirit  of 
salt)  ;  nitric  (aquafortis)  ;  acetic;  carbolic,  and  oxalic  acids. 

Symptoms. — Mucous  membrane  of  lips,  mouth,  and 
throat  greatly  inflamed  and  swollen,  with  more  or  less  de- 
struction of  the  tissue,  and  symptoms  of  shock.  When 
taken  in  a  concentrated  form,  muriatic  and  sulphuric  acids 
discolor  the  lips  and  mouth  hlacTx,  while  nitric  acid  stains 
these  yellow;  when  oxalic  and  carbolic  acids  have  been 
taken,  the  membrane  has  a  ivhitish  appearance. 

Treatment. — For  sulphuric,  muriatic,  nitric,  and  acetic 
acids;  immediate  use  of  alkalies,  as  mixtures  of  soda,  pot- 
ash, magnesia,  chalk,  white  crayons,  lime,  soap-suds,  or 
tooth-powder  (chalk) ;  raw  eggs,  milk,  oil.  Rectal  stimu- 
lation for  shock. 

Oxalic  Acid.— Is  sometimes  mistaken  for  Epsom  salts. 
Is  used  for  cleaning  kitchen  boilers,  etc.,  and  sometimes 
introduced  accidentally  into  food. 

Symptoms. — Same  as  other  corrosive  poisons. 

Treatment. — Magnesia  or  lime  in  some  form  should  be 
administered — the  latter  may  be  scraped  from  the  wall  or 
ceiling — white  crayons;  tooth-powders,  etc.  Soda,  potash, 
and  ammonia  should  not  be  used.  Castor-oil  or  sweet  oil 
should  be  administered  by  the  mouth,  and  hypodermic  or 
rectal  stimulation  resorted  to.  Poisoning  by  salts  of  lemon 
and  sorrel,  which  are  derivatives  of  oxalic  acid,  should  be 
treated  as  above. 

Carbolic  Acid  (Phenol)  Creasote.  Symptoms. — Same 
as  other  corrosives,  also  characteristic  odor  is  present; 
urine  small  in  amount  and  of  smoky  color. 

Treatment. — Alkalies,  particularly  sulphate  of  mag- 
nesia (Epsom  salts)  or  sulphate  of  soda  (Glauber's  salts) 
given  in  large  doses;  raw  eggs;  castor  oil,  and  sweet-oil. 
Emetic  if  necessary. 

CoRRosR'E  Sublimate. — (Bichloride  of  mercury.)  Used 
largely  as  a  disinfectant,  and  to  preserve  specimens,  etc. 


188  PROMPT  AID  TO  THE  INJURED. 

Symptoms. — Similar  to  those  of  arsenical  poisoning. 
Vomiting  and  purging;  intense  pain  in  abdomen;  mem- 
brane of  mouth  and  tongue  white  and  shriveled;  metallic 
taste  in  mouth. 

Treatment. — Emetics,  if  vomiting  is  not  present.  White 
of  egg  in  large  amount;  milk  or  mucilage  in  abundance; 
flour  and  water  or  arrowroot  or  barley-water;  chlorate  of 
potash.   Stimulants  by  hypodermic  or  rectal  administration. 

Alkalies. — Caustic  potash  and  soda;  pearlash;  strong 
solution  of  ammonia. 

Symptoms. — Similar  to  poisoning  by  corrosive  acids. 
Intense  swelling  and  inflammation  of  lips  and  mouth. 

Treatment. — The  treatment  consists  in  the  administra- 
tions of  acid^ — vinegar,  lemon  or  orange  juice,  hard  cider; 
also  acetic,  nitric,  muriatic,  and  sulphuric  acids  largely 
diluted;  raw  eggs;  olive-oil;  milk;  arrowroot,  and  bar- 
ley-water. Stimulants  by  hypodermic  or  rectal  adminis- 
tration.    Opium  may  be  given  to  allay  pain. 

Coal-Gas. — Symptoms. — Headache,  giddiness,  or  un- 
consciousness; cyanosis;  labored  respiration;  pupils  gen- 
erally dilated. 

Treatment. — Fresh  air;  oxygen;  artificial  respiration; 
stimulants.  When  the  case  is  in  the  hands  of  a  surgeon 
saline  venous  infusion  is  often  performed  in  extreme  cases. 

Poison  Ivy  or  Oak. — Symptoms. — A  vesicular  erup- 
tion of  a  brownish-red  color  appears;  this  may  be  associ- 
ated with  the  formation  of  large  blebs  or  blisters ;  the  skin 
becomes  very  red,  swollen,  hot,  and  irritable,  with  intense 
burning  and  itching. 

Treatment. — As  the  poison  is  due  to  a  volatile  acid,  an 
alkaline  application  is  indicated;  for  this  purpose  a  solu- 
tion of  baking  soda  or  saleratus  may  be  used,  or,  still 
better,  strong  soap-suds.  Later,  an  application  of  a  solu- 
tion of  the  acetate,  or  "sugar"  of  lead,  thirty  to  sixty 
grains  to  a  pint  of  water,  is  beneficial.  Dry  starch  dusted 
over  the  affected  part  is  also  used  at  this  stage.  Avoid 
ointments  or  other  oily  substances. 


CHAPTER   XVIII. 

THE  CONVULSIONS   OF  CHILDREN. 

Convulsions  affecting  children  are  of  common  occur- 
rence, but  do  not  carry  with  them  the  gravity  which  is 
associated  with  a  like  affection  in  adults.  The  convulsions 
are  often  the  result  of  trivial  causes,  as  indigestion,  teeth- 
ing, worms,  etc.  They  may  sometiuies,  however,  usher  in 
serious  affections,  as  scarlatina  (scarlet  fever).  At  the 
time  of  the  convulsion  the  thumbs  are  carried  across  the 
palm  of  the  hand  ;  the  eyes  are  set  and  turned  upward ; 
then  suddenly  the  patient  becomes  rigid,  with  some  con- 
traction of  the  facial  muscles ;  the  face  and  lips  become 
dusky,  as  the  result*  of  considerable  interference  with 
respiration.  This  rigidity  lasts  but  a  few  moments,  and 
is  generally  followed  by  a  stupor,  which  often  terminates 
in  a  natural  sleep  and  recovery. 

Treatment. — The  head  should  be  enveloped  in  a  cloth 
wet  with  cold  water,  and  the  child  at  once  placed  in  a  hot 
bath  (about  100°).  A  tablespoonful  of  mustard  may  be 
added  to  the  water,  the  efficiency  of  the  bath  being  there- 
by increased.  The  child  should  remain  in  the  bath  about 
two  or  three  minutes,  and  should  be  again  immersed  if 
the  convulsion  is  repeated. 

TETANUS— LOCKED-J  AW 

Tetanus  is  a  disease  characterized  by  spasmodic  rigidity 
of  the  voluntary  muscles,  and  is  sometimes  the  result  of  a 
wound  of  the  foot  or  hand,  made  by  a  blunt  or  jagged  im- 
plement, as  a  rusty  nail.  Tetanus  may  also  follow  burns. 
Cases  of  the  disease  are  not  frequent.    An  interval  of  from 


190  PROMPT   AID   TO    THE   INJURED. 

five  to  fifteen  days  generally  follows  the  reception  of  the 
injury  before  tlie  sj^mptoms  become  apparent. 

The  first  well-marlved  symptoms  of  the  disease  are  pain 
and  stiff ness "about  the  neck  and  jaws,  which  is  commonly 
mistaken  for  rheumatism.  This  increases  in  severity,  and 
the  muscles  of  mastication  become  involved  and  the  pa- 
tient is  unable  to  open  his  mouth  (trismus).  The  name 
by  which  the  disease  is  commonly  known  (locked-jaw)  is 
due  to  this  fact.  The  rigidity  about  the  neck  soon  extends 
to  other  portions  of  the  body.  The  strong  muscles  of  the 
back  being  so  forcibh'  contracted,  the  body  is  bent  in  the 
shape  of  a  bow  and  rests  on  the  head  and  heels  (opisthot- 
onos). The  upper  extremities  are  but  slightly  affected  in 
mild  cases.  The  contraction  of  the  facial  muscles  elevates 
the  corners  of  the  mouth,  and  produces  a  characteristic  ap- 
pearance known  as  risus  sardonicus,  or  canine  laugh.  This 
affection  is  usually  followed  by  a  fatal  result. 

Tetanus  is  to  be  distinguished  from  strychnine-poison- 
ing.   (See  Strychnine-Poisoning.) 

Treatment. — Medicine  is  of  very  little  use  in  tetanus  ; 
however,  large  doses  of  bromide  of  potassium  (thirty  to 
forty  grains)  may  be  given  with  safety  three  or  four  times 
daily).  The  value  of  tetanus  antitoxin  as  a  relief  for  this 
condition  is  now  fully  confirmed.  Operative  measures  are 
sometimes  undertaken  by  the  surgeon.  The  patient's 
strength  should  be  kept  up  as  well  as  possible  by  nour- 
ishment, such  as  milk,  beef -tea,  and  kumyss,  which  may 
be  carefully  poured  into  the  mouth  between  the  teeth  and 
cheeks;  in  this  way  it  reaches  the  stomach.  Excitement 
of  all  kinds  should  be  avoided. 

FOREIGN  BODIES  IN  THE  EYE,  EAR,  NOSE,  LARYNX,  AND 

PHARYNX. 

Eye. — Eoreign  bodies  in  the  eye  usually  consist  of 
cinders,  sand,  dust,  and  minute  scales  of  iron.  The  latter 
have  become  a  frequent  source  of  annoyance  since  the  ele- 
vated railroads  have  been  in  operation. 


FOREIGN    BODIES   IN   THE   EAR.  191 

T^reatment. — The  foreig-n  bodies  just  described  are 
usually  lodged  about  the  center  and  under  surface  of  the 
upper  lid,  and  are  often  washed  out  of  the  eye  by  the 
increased  flow  of  tears  which  follows  their  introduction. 
If  the  foreign  body  still  remains  lodged,  the  upper  lid 
should  be  gently  pulled  away  from  the  eye  with  the  thumb 
and  finger,  and  carried  downward  and  pressed  against 
the  lower  lid,  to  which  the  particle  may  be  transferred. 
Should  this  not  be  successful,  the  upper  lid  may  be  turned 
upward  and  folded  on  itself  over  a  pencil,  when  the  foreign 
body  can  generally  be  seen  and  removed  by  lightly  touch- 
ing it  with  a  small  fold  of  a  clean  handkerchief  or  other 
similar  substance.  The  operation  of  eversion,  or  turning 
the  lid  upward,  usually  requires  considerable  practice  be- 
fore it  can  be  done  dexterously.  The  lower  edge  of  the 
upper  lid  should  be  carried  away  from  the  eye  and  some- 
what upward  by  seizing  the  lid  with  the  thumb  and  fore- 
finger of  the  left  hand — the  operator  standing  in  front  of 
the  patient — while  with  the  tip  of  the  index-finger  of  the 
other  hand,  or  the  shaft  of  a  lead-pencil,  the  center  of  the 
lid  is  pressed  downward,  and  the  inner  surface  is  exposed. 
The  particles  of  iron  already  referred  to,  and  also  some 
other  foreign  bodies,  have  sharp  cutting  edges,  and  often 
penetrate  the  eyeball,  usually  over  the  pupil,  and  can 
not  be  dislodged  by  the  ordinary  process.  All  unskillful 
manipulation,  and  also  the  common  practice  of  rubbing 
the  eye,  press  the  substance  still  deeper  into  the  structures. 
This  condition  should,  if  possible,  be  attended  to  by  a  sur- 
geon. The  pain  and  reddened  condition  of  the  eye  may 
be  relieved  by  applications  of  warm  water,  tea,  or  rose- 
water,  or  two  or  three  drops  of  a  four-per-cent  solution  of 
cocaine  dropped  in  the  inner  corner  of  the  eye. 

Ear. — Grreater  danger,  probably,  results  from  the  un- 
skillful, unnecessary,  and  rough  manipulation,  in  cases 
where  foreign  bodies  have,  been  introduced  into  the  ear, 
than  from  the  presence  of  the  article  itself.  A  foreign 
body,  even  of  large  size,  which  does  not  cause  immediate 


192  PROMPT  AID   TO   THE   INJURED. 

pain  and  distress,  may  remain  in  the  ear  for  some  time 
without  causing  any  serious  result.  It  can,  at  least,  re- 
main until  removed  in  a  proper  manner  by  a  surgeon. 
Only  the  simplest  and  gentlest  measures  should  be  em- 
ployed by  a  non-medical  person.  Among  the  foreign 
bodies  which  are  found  in  the  ear  are  insects,  bugs,  peas, 
beans,  pebbles,  cherry-pits,  and  shoe-buttons.  Children 
commonly  introduce  the  latter  articles  into  their  own  ears 
or  the  ears  of  playmates.  It  is  well  to  be  reasonably  cer- 
tain that  a  foreign  body  exists  in  the  ear  before  an  attempt 
is  made  to  dislodge  it. 

Treatment. ^-Bugs  and  insects  are  readily  removed  by 
carefully  syringing  the  affected  ear  with  warm  water ; 
or,  if  a  syringe  can  not  be  procured,  then  water  can  be 
poured  into  the  ear.  This  procedure  either  drowns  the 
insect  or  drives  it  out,  and  is  so  uniformly  successful  and 
simple  that  it  is  regarded  as  the  best  treatment  for  this 
pui'pose.  Another  method,  which  is  commonly  employed, 
consists  in  applying  a  piece  of  cotton  saturated  with  salt 
water  or  vinegar  to  tlie  ear,  and  when  the  cotton  is  re- 
moved, after  an  interval  of  a  few  minutes,  the  insect  is 
usually  found  attached  to  it.  Gentle  syringing  may  also 
be  employed  to  remove  other  foreign  bodies  from  the  ear ; 
exception  should,  Jioicever,  be  made  zchen  the  substance 
is  likely  to  be  increased  in  size  by  the  use  of  ivater,  as 
peas  and  beans.  Tooth-picks,  button-hooks,  and  other 
similar  instruments,  should  never  be  used  ;  for  when  they 
are  employed,  the  foreign  body  is  almost  always  pushed 
further  into  the  canal,  and  its  subsequent  extraction  by 
the  surgeon  made  more  difficult,  besides  the  drum  of  the 
ear  is  very  liable  to  be  perforated,  or  other  unpleasant 
accidents  ensue. 

Nose. — Foreign  bodies  are  often  inserted  into  the  nose 
by  children  and  insane  persons,  or  as  the  result  of  accident. 
The  article  introduced  may  be  small  and  not  particularly 
irritating,  and  may  remain  in  the  nasal  cavity  for  a  long 
time  before  its  presence  is  known. 


FOREIGN    BODIES   IX   THE   LARYNX.  ]9:» 

Treatment.  —  Tickling  the  opposite  nostril  with  a 
feather  until  sneezing  is  induced,  is  very  often  all  that  is 
necessary,  particularly  if  the  foreign  body  has  recently 
been  inserted.  If  some  such  simple  procedure  just  de- 
scribed is  not  followed  by  the  desired  result,  the  case 
should  be  seen  as  early  as  possible  by  a  surgeon. 

Larynx. — Foreign  bodies  may  enter  the  larynx  during 
a  fit  of  laughing,  or  when  a  sudden  act  of  inspiration  is 
made ;  this  occasionally  occurs  while  eating.  A  piece  of 
meat  is  often  a  cause  of  strangulation.  The  obstruction  to 
the  entrance  of  air  into  the  lungs  is  immediately  followed 
by  a  violent  paroxysm  of  coughing,  which  usually  expels 
the  foreign  body  ;  if  not  dislodged,  evidences  of  suffocation 
immediately  follow.  The  face  becomes  congested  and  the 
eyes  protrude ;  the  inspirations  are  gasping  in  character, 
and  the  patient  makes  frantic  efforts  for  relief.  The  sub- 
stance causing  the  obstruction  is  usually  in  such  a  position 
that  some  air  reaches  the  lungs. 

Treatment. — The  nearest  surgeon  should  at  once  be 
sent  for,  and  always  informed  as  to  the  character  of  the 
case,  in  order  that  he  may  bring  with  him  the  instruments 
necessary  for  an  operation,  which  usually  consists  of  an 
external  opening  into  the  windpipe.  In  the  mean  time 
the  subject  should  be  slapped  violently  on  the  upper  por- 
tion of  the  back  between  the  shoulder-blades,  particularly 
at  the  moment  of  coughing.  If  this  is  not  successful,  in- 
vert the  body — that  is,  hold  the  patient  by  his  feet  with  the 
head  down — and  again  slap  the  back.  This  should  at  once 
be  discontinued  if  it  increases  the  distress.  If  the  accident 
occurs  during  a  meal,  the  finger  should  be  passed  into  the 
throat,  with  a  possibility  of  dislodging  the  piece  of  meat 
or  whatever  may  cause  the  mischief. 

If  the  patient  becomes  unconscious  from  the  consequent 
asphyxia,  artificial  respiration  should  be  employed  until 
the  surgeon  arrives.  Fresh  air,  or  the  use  of  oxj'gen  con- 
tained in  cylinders,  is  of  value  in  the  treatment. 

Pharynx. — The  local  distress  caused  bv  foreign  bodies 
14 


194  PROMPT    AID   TO   THE   INJURED. 

in  the  pharynx — which  usually  consist  of  articles  of  food, 
coins,  fish-bones,  pins,  needles,  false  teeth — depends  upon 
their  size,  which,  if  large,  produce  more  or  less  pressure 
over  or  upon  the  aii^-passage,  together  with  symptoms  sim- 
ilar to  those  of  foreign  bodies  in  the  larynx ;  or,  if  sharp- 
pointed,  the  article  may  cause  great  pain  and  irritation. 

Treatment. — Foreign  bodies  in  the  pharynx  are  often 
removed  by  acts  of  vomiting  or  coughing ;  if  not  so  ex- 
pelled, an  examination  of  the  throat  should  be  made,  and, 
if  possible,  the  substance  removed  ;  if  this  can  not  be  done, 
and  the  foreign  body  is  not  too  large  or  sharp,  it  may  be 
pushed  downward  into  the  stomach.  A  fish-bone,  pin,  or 
needle  is  almost  always  found  sticking  into  the  mucous 
membrane,  and  care  should  be  observed,  while  trying  to 
remove  it,  that  it  is  not  forced  still  further  into  the  tissues. 

Children  often  swallow  coins,  buttons,  etc.,  and  some- 
times substances  of  very  large  bulk.  When  this  occurs, 
emetics  and  cathartics  should  not  be  given.  Emetics  are 
objectionable,  because  it  is  safer  to  have  the  foreign  body 
pass  downward  through  the  alimentary  tract.  Instances 
have  occurred  where  coins,  etc.,  have  been  brought  up  by 
the  use  of  emetics  and  have  entered  the  air-passages  before 
they  could  be  expelled  from  the  mouth.  Cathartics  should 
not  be  used,  for  the  reason  that  they  irritate  the  intestinal 
tract  without  doing  any  good.  The  cliild  should  receive 
the  usual  food,  with  the  addition  of  wheat  or  rye  flour  in 
the  form  of  a  gruel;  this  material  adheres  to  the  foreign 
body,  and  prevents  it  from  irritating  the  canal  on  its  way 
down.  After  a  foreign  body,  such  as  is  usually  swallowed, 
reaches  the  stomach,  it  is  rarely  followed  by  a  serious  result. 

The  passages  from  the  bowel  should  always  be  carefully 
examined  for  the  substance,  which  usually  makes  its  ap- 
pearance within  three  days.  The  medical  attendant  must 
be  at  once  informed  if  the  child  becomes  restless  or  fever- 
ish, or  is  affected  with  pain. 


FOOT-SORENESS.  195 

The  following"  very  valuable  remarks,  in  regard  to  foot- 
soreness,  are  made  by  Prof.  Parkes  (Parkes'  "  Manual  of 
Hygiene  ")  : 

"Foot-soreness  is  generally  a  great  trouble,  and  fre- 
quently arises  from  faulty  boots,  undue  pressure,  chafing, 
riding  of  the  toes  from  narrow  soles,  etc.  Rubbing  the 
feet  with  tallow  or  oil,  or  fat  of  any  kind,  before  marching, 
is  a  common  remedy.  A  good  plan  is  to  dip  the  feet  in 
very  hot  water  before  starting,  for  a  minute  or  two ;  wipe 
them  quite  dry,  then  rub  them  with  soap  (soft  soap  is  the 
best)  till  there  is  a  latlier ;  then  put  on  the  stockings.  At 
the  end  of  the  day,  if  the  feet  are  sore,  they  should  be 
wiped  with  a  wet  cloth,  and  rubbed  with  tallow  and  spirits 
mixed  in  the  palm  of  the  hand  (Galton).  Pedestrians  fre- 
quently use  hot  salt  and  water  at  night,  and  add  a  little 
alum.  Sometimes  the  soreness  is  owing  simply  to  bad 
stockings  ;  this  is .  easily  remedied.  Stockings  should  be 
frequently  washed,  then  greased.  Some  of  the  German 
troops  use  no  stockings,  but  rags  folded  smooth  over 
the  feet. 

"  Very  often  the  soreness  is  owing  to  neglected  corns, 
bunions,  or  in-growing  nails.  If  blisters  form  on  the  feet, 
the  men  should  be  directed  not  to  open  them  during  the 
march,  but  at  the  end  of  that  time  to  draw  a  needle  and 
thread  through  ;  the  fluid  gradually  oozes  out. 

"  All  foot-sore  men  should  be  ordered  to  report  them- 
selves at  once." 

A  powder  composed  of  salicylic  acid  three  parts,  starch 
ten  parts,  and  talc  eighty-seven  parts,  maj^  be  dusted  over 
the  feet  daily,  or  every  two  or  three  days. 

CHAFING. 

Chafing  is  particularly  common  among  soldiers,  and 
is  generally  due  either  to  the  friction  caused  by  badly 
fitting  clothes  or  where  surfaces  of  the  skin  rub  together, 
as  tlie  inside  of  tlie  thigh,  or  at  the  flexures  or  bendings  of 
the  different  joints  of  the  body. 


196  PROMPT   AID    TO   THE  INJURED. 

Treatment. — The  cause  of  irritation  should  be  re- 
moved if  possible,  and  the  affected  parts  washed  with  cold 
water,  dried  thoroughly,  and  then  dusted  with  fuller's 
earth,  bismuth,  Ijcopodium,  oxide  of  zinc,  starch,  oatmeal, 
or  flour.  Fuller's  earth  is  superior  to  the  others  men- 
tioned for  this  purpose;  equal  parts  of  lycopodium  and 
talc  is  excellent  to  prevent  chafing ;  flour  and  starch  are 
apt  to  become  sour,  and  increase  the  local  irritation. 

Unless  the  affection  is  promptly  attended  to,  inflamma- 
tion of  the  skin  may  follow,  Avhich  requires  rest  together 
with  active  and  sometimes  prolonged  treatment. 


CIIAPTEU    XIX. 
HYGIENE. 

The  subject  of  hygiene,  which  relates  to  the  care  and 
preservation  of  health  and  prevention  of  disease,  may  very 
properly  be  introduced  by  indicating  in  a  general  way  the 
manner  in  which  the  body  should  be  cared  for.  In  order 
to  intelligently  understand  this  matter,  a  general  knowl- 
edge of  anatomy  and  physiology  is  necessary. 

It  will  be  seen  that  the  skin  is  an  exceedingly  active 
organ,  constantly  throwing  off  the  perspiration,  which 
contains  considerable  waste  matter;  in  addition,  the  seba- 
ceous follicles  supply  an  oily  substance  for  lubrication; 
these,  with  the  worn-out,  scaly,  or  superficial  layer  of  the 
skin,  produce  a  large  amount  of  effete  or  decomposed  ma- 
terial, which,  if  not  promptly  removed,  embarrasses  the 
function  of  this  organ  and  favors  the  formation  of  un- 
pleasant odors.  It  will  thus  be  appreciated  that  cleanli- 
ness is  essential  to  health. 

5a#^s.— Considerable  has  been  written  upon  the  sub- 
ject of  baths,  and  numerous  and  complicated  methods  have 
been  advocated.  These  in  a  great  measure  are  luxuries, 
and  are  not  necessary  to  the  well-being  of  the  body.  A 
cold  bath  upon  rising,  the  water  to  be  applied  by  the  hand 
and  followed  by  moderate  friction,  is,  as  a  rule,  sufficient 
to  keep  the  skin  properly  cleansed  and  stimulated.  This 
applies  to  healthy  adults,  and  is  not  recommended  for 
children  and  old  people.  In  the  latter  subjects  a  warm 
bath  at  bedtime,  two  or  three  times  weekly,  will  suffice. 
Plunging  into  a  tub  of  cold  water,  particularly  in  the 


198  PROMPT   AID   TO   THE   INJURED. 

winter  time,  is  of  questionable  value,  and  can  only  be  done 
with  safety  by  the  strongest.  If  the  desired  effect  is  ob- 
tained, the  use  of  cold  water  should  be  promptly  followed 
by  a  glow  or  reaction. 

Warm  baths  during  the  day  should  be  followed  by  the 
application  of  cold  water,  which  renders  a  person  less  sus- 
ceptible to  exposure.  The  temperature  of  a  bath  can  be 
changed  without  any  ill  effects.  Baths  (except  those  upon 
rising  in  the  morning)  should  not  be  taken  just  before 
or  after  a  meal.  Cold  baths  should  not  be  taken  when 
hungry  or  fatigued. 

"Warm  baths  are  soothing,  and  allay  nervous  irrita- 
biUty. 

While  Russian  and  Turkish  baths  are  often  valuable 
for  therapeutical  purposes  and  as  extreme  cleansing  agents, 
they  are  rather  sources  of  pleasure,  and  are  not  essential 
to  the  welfare  of  the  skin.  Sea-bathing  is  usually  over- 
done, and  often  followed  by  unsatisfactory  results.  Per- 
sons suffering  from  head  and  chest  affections  should  not  go 
into  the  sea.  Adults  should  not  remain  in  the  surf  longer 
than  fifteen  or  twenty  minutes,  and  children  and  old  and 
delicate  subjects  even  less.  Noon  is  perhaps  the  best  time 
of  day  for  sea-bathing,  and  the  bath  should  not  be  taken 
close  to  meal-time.  The  bather  should  not  wait  to  cool 
off,  but  plunge  in  at  once  and  immerse  the  whole  body ; 
when  warm,  a  person  can  better  stand  the  shock  of  the 
cold  water.  After  the  bath  the  body  should  be  quickly 
dried,  and  a  brisk  walk  taken. 

The  addition  of  alcohol,  cologne,  ammonia,  etc.,  make 
the  bath  particularly  pleasant  and  stimulating.  The  effect, 
however,  is  local,  as  the  skin  has  very  little  if  any  absorb- 
ent power.  The  different  nutritive  and  medicinal  baths 
given  with  this  end  in  view  are  practically  worthless. 
Shipwrecked  persons  and  those  who  are  in  the  water  a 
good  portion  of  the  time  require  less  drink,  not  because 
the  skin  absorbs  water,  but  because  the  long-continued 
contact  of  the  water  lessens  the   activity  of  the  sweat 


HYGIENE.  lf)(j 

glands,  and  consequently  less  water  is  thrown  oflp  from 
the  body.  When  a  daily  bath  is  taken,  unless  the  weather 
is  very  warm,  soap  is  unnecessary,  except  to  apply  to  those 
portions  of  the  body  which  are  exposed  and  where  sur- 
faces are  in  contact  with  each  other.  Too  much  soap  re- 
moves the  oily  substances  and  renders  the  skin  dry  and 
harsh.  Soldiers  and  others  who  are  moving  about  and 
can  not  enjoy  a  regular  bath  should,  if  possible,  bathe  the 
portions  of  the  body  just  referred  to. 

Special  care  should  be  given  to  the  feet,  not  only  as  a 
matter  of  cleanliness,  but  to  aid  the  proper  locomotion. 
An  ingrowing  nail  or  neglected  corn  often  renders  a  sol- 
dier unfit,  for  duty.  The  feet  should  be  bathed  morning 
and  evening;  the  nails  frequently  trimmed — not  too  close, 
as  this  causes  the  toes  to  become  clubbed.  Corns  should 
be  soaked  in  warm  water  and  scraped,  not  cut. 

The  mouth  and  teeth  should  be  cleaned  twice  daily 
with  a  soft  brush  ;  good  soap  may  be  used  for  this  pur- 
pose. This  procedure  removes  particles  of  food,  etc.,  helps 
to  preserve  the  teeth,  and  prevents  oftentimes  an  unpleas- 
ant breath. 

Dandruff  is  the  scaly  layer  of  the  scalp ;  the  excess  can 
generally  be  removed  by  brushing  ;  a  fine  comb  should 
not  be  used.  The  scalp  can  occasionally  be  washed  with 
warm  water  and  soap  or  borax,  and  afterward  washed  with 
cold  water.  Too  much  soap  or  cosmetic  changes  the  color 
of  the  hair.  Inferior  soap  frequently  irritates  the  skin, 
and  should  not  be  used. 

Clothing . — It  is  generally  accepted  that  woolen  is  the 
best  material  for  clothing  of  all  kinds.  Its  hygroscopic 
properties — i.  e.,  the  power  which  it  possesses  for  absorb- 
ing water  and  its  action  as  a  nonconductor — make  it  par- 
ticularly valuable  for  the  above  named  purpose.  As  a 
nonconductor  it  does  not  transmit  the  sun's  rays  in  warm 
weather  nor  the  body  heat  in  winter.  The  latter  heat  is 
in  a  great  measure  regulated  by  the  perspiration,  which  is 
readily  absorbed  by  wool,  and  helps  to  cool  the  surface 


200  PROMPT  AID   TO   THE   INJURED. 

during  a  high  temperature.  Cotton  and  linen,  being  good 
conductors,  transmit  the  sun's  rays  and  also  the  warmth 
of  the  body.  The  chilly  and  clammy  feeling  which  is 
often  experienced  when  cotton  is  worn  next  the  skin  does 
not  occur  when  the  material  is  woolen.  For  this  reason 
the  latter  is  particularly  indicated  for  wear  by  those  who 
are  subject  to  chest  affections,  rheumatism,  etc.  When  it 
is  necessary  that  the  surface  of  the  body  should  be  kept 
uniformly  w^arm,  woolen  should  be  worn  at  night  as  well 
as  during  the  day.  A  common  prejudice  exists  against 
the  use  of  woolen  as  underwear,  the  objection  being  that 
it  u'ritates  the  skin.  At  the  present  day  woolen  under- 
garments may  be  procured  almost  as  soft  as  silk,  and  very 
thin.  Silk  as  an  article  of  clothing  for  underwear  stands 
next  to  wool  in  value,  linen  and  cotton  last. 

More  or  less  cotton  is  generally  found  in  woolen  goods. 
If  the  amount  is  small,  it  does  not  materially  interfere 
with  the  properties  of  the  wool,  and  helps  to  prevent  the 
excessive  shrinking  which  would  otherwise  take  place. 
Besides,  25  or  30  per  cent  of  cotton  renders  the  garment 
more  serviceable.  The  shrinking  may  be  in  a  measure 
controlled  if  the  garments  are  soaked  and  stirred  in  hot 
soap-suds  and  transferred  to  cold  water  (to  remove  soap) 
without  wringing. 

Woolen  stockings  are  often  objectionable,  because  the 
leather  foot-wear,  being  also  a  bad  conductor,  keeps  the  feet 
tender,  moist,  and  offensive.  The  popular  notion  that  red 
woolen  flannel  is  superior  to  the  uudyed  is  fallacious. 
This  material  is  disagreeable,  as  the  dje  increases  the  ab- 
sorption of  offensive  odors. 

Head- wear  should  be  worn  as  little  as  possible.  It 
should  be  easy  fitting,  light  in  weight,  and  ventilated. 
Baldness  frequently  follows  a  disregard  of  these  rules. 

Comforters  and  other  articles  worn  about  the  neck,  ex- 
cept on  special  occasions,  are  to  be  condemned  ;  they  keep 
the  skin  moist  and  tender. 

A   number  of  coverings  of  clothing  is  warmer  than 


HYGIENE.  201 

ODe  of  equal  thickness,  due  to  the  air  between  the  several 
garments. 

Leather  clothing  is  a  bad  conductor,  and  very  warm, 
but  should  only  be  worn  in  extremely  cold,  dry,  or  windy 
weather. 

Rubber  clothing  prevents  proper  evaporation  and  keeps 
the  body  and  underwear  moist,  and  should  be  worn  only 
in  wet  weather  and  when  other  protection  is  not  available. 

Ordinary  garments  can  be  transformed  into  fairly 
good  waterproof  material  in  one  of  the  following  ways  : 

1.  Moisten  the  cloth  on  the  wrong  side  with  a  weak 
solution  of  isinglass,  and  when  dry  further  moisten  with 
an  infusion  of  nutgall. 

2.  Moisten  the  cloth  on  the  wrong  side  with  a  solution 
of  soap,  and  when  dry  with  a  solution  of  alum. 

3.  Thoroughly  rub  the  wrong  side  of  the  cloth  with 
pure  beeswax  until  it  presents  an  even  gray  appearance  ;  a 
hot  iron  is  then  to  be  passed  over  it,  and  the  cloth  brushed 
while  still  warm. 

Shoes  should  be  made  with  broad  soles,  not  too  thick, 
to  prevent  the  proper  bending  of  the  feet. .  Boots  or  shoes 
should  never  be  worn  on  alternate  feet.  Boots  sweat  the 
legs,  and  should  be  worn  only  when  necessary. 

Parke's  water-proof  dressing  is  a  very  valuable  prepara- 
tion, and  is  made  as  follows  :  Dissolve  carefully  with  heat 
half  a  pound  of  shoemaker's  dubbing  in  half  a  pint  of 
linseed-oil  and  half  a  pint  of  solution  of  India-rubber,  and 
use  on  boots  and  shoes  every  two  or  three  months. 

Tight  lacing,  garters,  and  straps  about  the  waist  should 
be  avoided ;  the  latter  is  said  to  favor  the  formation  of 
hernia  or  rupture. 

Food. — The  function  of  food  has  been  likened  to  the 
fuel  which  supplies  the  engine,  but,  aside  from  supplying 
material  which  keeps  the  difPerent  functions  of  the  body 
in  activity,  it  furnishes  material  for  new  tissue  to  supply 
the  waste  which  is  constantly  going  on.  Food  may  be 
divided  into  organic  and  inoriranic  substances. 


202  PROMPT   AID   TO   THE   INJURED. 

An  organic  substance  is  one  which  supplies  the  body 
with  nourishment,  heat,  and  motion,  and  forms  new  tissue 
to  replace  that  which  is  worn  out.  In  performing*  this  it 
loses  its  identity,  and  when  eliminated  from  the  body  is  in 
the  form  of  waste  tissue. 

Organic  substances  are  divided  into  organic  nitrogen- 
ized  and  organic  non-nitrogenized. 

Organic  nitrogenized  matter  or  albuminous  material 
contains  nitrogen,  and  is  the  most  important  of  all  foods. 
It  rebuilds  worn-out  tissue,  supplies  motion,  strength,  and 
nourishment.  The  white  of  egg,  caseine  of  milk,  and 
gluten  of  flour  are  examples  of  this  class. 

The  organic  non-nitrogenized  substances,  examples  of 
which  are  starches  and  sugars  (carbohydrates)  and  fats 
(hydrocarbons),  are  necessary  to  sustain  proper  nutrition, 
supply  heat  as  the  result  of  oxidation,  protect  the  deeper 
structure,  and  give  symmetry  to  the  body.  Recent  investi- 
gators have  shown  that  the  non-nitrogenized  substances 
have  considerable  to  do  with  the  production  of  force  or 
energy  in  addition  to  their  other  functions. 

It  will  thus  be  understood  why  an  athlete  chooses  a 
diet  composed  principally  of  organic  nitrogenized  food, 
which  forms  muscles  without  materially  increasing  the 
body  weight. 

Inorganic  substances  are  those  which  are  taken  into  the 
system,  perform  a  definite  function,  and  are  then  removed 
from  the  body  unchanged.  Water  and  salt  are  examples  of 
this  class.  Water  exists  in  every  tissue  of  the  body,  and  is 
essential  to  their  integrity.  In  cholera,  where  the  water  is 
rapidly  removed,  the  body  has  a  shrunken  and  pinched  ap- 
pearance, the  features  in  some  cases  being  unrecognizable. 
Salt  is  necessary  to  the  proper  interchange  of  nutrition. 
When  deprived  of  this  substance  the  body  rapidly  suffers. 

All  tissues  of  the  body  are  constantly  undergoing  phys- 
iological change,  and  for  this  the  food  we  eat  must  contain 
the  different  materials  above  enumerated.  This  is  im.pera- 
tive,  and  has  been  confirmed  by  numerous  experiments. 


HYGIENE. 


20:3 


Ordinary  articles  of  food  contain  50  to  60  per  cent  of 
water.  It  is  generally  accepted  tliat  a  diet  should  contain 
one  part  of  nitrog-en  (contained  in  organic  nitrogenized 
matter)  and  twelve  to  fifteen  parts  of  carbon  (found  in 
organic  non-nitrogenized  food).  Parke  states  that  a  man 
in  good  health  and  doing  a  good  day's  work  must  have 
about  two  thirds  of  an  ounce  of  nitrogen  and  eight  to 
twelve  ounces  of  carbon. 

The  following  interesting  facts  are  given  by  Dr.  Wil- 
son :  One  ounce  of  albuminous  material  (organic  nitro- 
genized) contains  70  grains  of  nitrogen  and  212  grains  of 
carbon ;  one  ounce  of  the  fat  (hydrocarbon)  contains  336 
grains  of  carbon  ;  one  ounce  of  the  starches  and  sugars 
(carbohydrates)  contains  190  grains  of  carbon. 

With  these  facts  in  view,  a  proper  diet  can  be  easily 
selected  from  the  following  table  of  Dr.  Letheby,  which 
includes  the  ordinai'y  articles  of  food  (uncooked) ;  20  per 
cent  should  be  deducted  for  bone,  and  the  same  percentage 
for  cooking : 


Split  peas 

Indian  meal 

Barley  meal 

Rye 

"Seconds"  flour. 

Oat  meal 

Baker's  bread . . . . 

Pearl  barley 

Rice 

Potatoes 

Turnips 

Green  vegetables. 

Carrots 

Parsnips 

Sugar 

Treacle 

Buttermilk 

Whey 

Skimmed  milk. . . 


QRAn 

r  PER   1 

POUND. 

Carbon. 

Nitrogen. 

2,699 

248 

3,016 

120 

2,563 

68 

2,693 

86 

2,700 

116 

2,831 

136 

1,975 

88 

2,660 

91 

2,732 

68 

769 

22 

263 

13 

420 

14 

508 

14 

554 

12 

2,955 

,  ,  , 

2,395 

•  ■  « 

387 

44 

154 

13 

438 

43 

New  milk 

Skim  cheese.. . . 
Chedder  cheese . 
Bullock's  liver. . 

Mutton 

Beef 

Fat  pork 

Dry  bacon 

Green  bacon  . . . 

Whitefish 

Red  herring. . . . 

Dripping 

Suet 

Lard 

Salt  butter 

Fresh  butter . . . 

Cocoa  

Beer  and  porter 


ORAIN  PER 
POUND. 


Carbon. 

Kitrogea. 

599 

44 

1,949 

483 

3,344 

306 

934 

204 

1,900 

189 

1,854 

184 

4,113 

106 

5,987 

95 

5,426 

76 

871 

195 

1,435 

217 

5,456 

4,710 

4,819 

4,585 

6,456 

3,944 

iio 

274 

1 

204 


PROMPT  AID   TO   THE   INJURED. 


The  following  table  is  given  by  Dr.  Dalton.  A  man 
in  good  health,  taking  active  exercise  in  the  open  air  and 
restricted  to  a  diet  of  bread,  butter,  and  fresh  meat,  with 
water  and  coffee  for  drink,  consumes  in  one  day : 

Meat,  16  ounces. 

Bread,  19  ounces. 

Butter  or  fat,  3'5  ounces. 

Water,  54  ounces. 

Climate  has  considerable  to  do  with  the  formation  of 
the  quantity  and  quality  of  the  dietary.  This  is  well 
marked  in  the  arctic  regions,  where  an  enormous  quantity 
of  fat  is  consumed,  thus  furnishing,  besides  food,  heat  and 
protection. 

Cojnposition  of  Different  Articles  of  Diet. 
Table  from  "  Hygiene,"  Notter  and  Firth,  1900. 


Im  100  Parts. 


Watei' 


Pro- 
teids. 


Arrowroot 15  ■ 

Bacon  (Letheby) 15 ' 

Barley  meal  (de  Chaumont) 11' 

Barley  pearl  (Church) 14- 

Beef,  best  quality  (Konig) 72  ■ 

Beef  as  supplied  to  army 75 ' 

Beef,  salted .' 49' 

Beef,  corned  or  Chicago  (Parkes).  .  52' 

Beetroot  (Konig) 8' 

Biscuits 

Bread  (Rubner) 

Bread,  average  wheaten 

Butter,  English  fresh  (Bell) 112 

Butter,  very  best  (Bell).  . . 

Butter,  salt  (Bell) 

Butter,  highly  salted  (Bell) 

Cabbage  (Konig) 

Cabbage.  Brussels  sprouts 

Carrots  (Konig)  

Cheese,  Dutch  (Bell) 

Cheese,  single  Gloster    .  .  . 
Cheese,  poor  quality  (Bell) 


•40 

0^ 

•00 

9^ 

•30 

12  • 

•70 

7- 

•00 

21- 

•00 

15  • 

•10 

29  • 

•20 

23  • 

•00 

1^ 

•00 

15  • 

•50 

8- 

•00 

8- 

•00 

2- 

•00 

1- 

•00 

.  .  . 

•00 

1- 

•00 

2- 

•50 

5^ 

'•80 

1- 

•00 

28- 

.•00 

31  • 

i^OO 

32  • 

Fats. 


•80 
•00 
70 
■40 
•00 
■00 
■60 
■30 
•50 
•60 
■00 
•00 
•00 
•00 

•66 

00 
00 
■00 
•00 
■00 
•00 


00 
00 
10 
00 
40 
•20 
•00 


Car- 
bohy- 
drates 


71^00 
75-80 


30 
00 
•50 
■00 
■00 
•00 
•00 
•00 
■50 
•20 
•00 
■50 
•00 


10-50 
73^40 
50^00 
49-20 


Salts. 


0-30 
3-00 
3-00 
1-00 
1-00 
1^60 
21-10 


00 
00 
70 
50 
30 
00 
00 
3-00 
8-00 


5-50 

7-80 

10-00 

1-00 


■00 


50 
■20 
■00 
•00 
•50 
•00 


HYGIENE. 


205 


In  100  Parts. 


Cream  (Letheby) 

Eel(Konig) • 

Eggs 

Fish,  salmon  (Konig) 

Fish,  sole  (Konig) 

Fish,  herrings  fresh  (Konig) 

Flour,  wheaten  fine 

Flour,  wheaten  average 

Goose  (Konig) 

Horse-flesh  (Konig) 

Lentils 

Macaroni  (Konig) 

Maize  (Pozziali) 

Margarine 

Milk,  average  cow's 

Milk,  Devon  preserved  (Blyth)  . . . . 

Milk,  average  town 

Milk,  condensed  English  (Bell). . . . 
Milk,  condensed  Swiss,  sweetened. . 
Milk,  condensed  Swiss,  unsweetened 

Mutton,  ordinary 

Oat  meal 

Parsnips  (Parkes) 

Peas 

Pork  (Konig) 

Potatoes 

Rice 

Turnips  (Konig) 

Veal,  lean  (Konig) 


Water 


Pro- 
teids. 


00    2 
5012 


Fats. 


70  26 

50128 

50|11 

00    7 

00   0 

00 

00 

00 

00 

70 

80 

00 

00 

75 

70 

20 

00 

00 

30' 11 

35III 

OOi  5 

00!  6' 

30    0 


Car- 
bohy- 
drates 


2- 

08- 
71- 

58- 
76- 
64- 

4- 

3- 

4- 

50- 

48- 
13- 

63- 
14- 

58- 

21- 

84- 

6- 

80 

30 
20 

40 
80 
50 

26 
50 
30 
80 
70 
35 

06 
50 
00 

84 
40 
80 

Salts. 


•80 
•50 
•40 
•00 
•50 
•00 
•70 
•80 
•50 
•00 
•50 
•80 
•40 
•22 
•70 
•70 
•70 
•00 
•40 
•00 
•00 
•00 
•00 
•40 
•50 
•00 
•50 
•00 
•50 


The  term  "  Froteids "  which  appears  in  the  above  table  refers  to 
organic  nitrogenized  matter. 

Milk  contains  the  essential  elements  necessary  to  a 
varied  diet,  and  is  the  sole  nourishment  during  infancy 
and  the  principal  article  of  diet  during  the  first  five  or  six 
years  of  life,  and  even  later.  Milk  is  capable  of  sustaining 
life  and  health  indefinitely  in  an  adult.  The  different 
forms  of  aliment,  however,  may  after  childhood  be  ad- 
vantageously taken  in  a  more  condensed  form,  as  milk 


206  PROMPT  AID   to   THE   IXJURED. 

contains  about  86  per  cent  of  water.  The  specific  gravity 
of  good  milk  is  between  1,017  and  1,036.  There  should  be 
10  or  12  per  cent  by  volume  of  cream.  When  used  for  in- 
fants under  six  months  of  age  the  milk  should  be  diluted 
with  25  to  100  per  cent  of  water,  and  the  addition  of  a 
small  amount  of  sugar  and  cream.  Milk  is  highly  absorb- 
ent, and  rapidily  becomes  tainted  in  an  impure  atmos- 
phere. When  the  purity  of  milk  is  questioned,  or  during* 
the  presence  of  cholera,  typhoid  fever,  diphtheria,  etc.,  it 
should  be  boiled  (212°  Fahrenheit).  If  this  is  properly  car- 
ried out,  the  infectious  germs  which  it  may  contain  will  be 
destroyed.  However,  as  boiling  more  or  less  impairs  the 
value  of  milk  as  an  article  of  nutrition,  it  is  better  under 
ordinary  circumstances  for  infant  feeding  to  depend  on 
Pasteurization  for  safety.  In  this  process  the  milk  is  sub- 
jected to  a  temperature  of  156°  Fahrenheit  for  a  half  or 
three-quarters  of  an  hour.  While  this  greatly  diminishes 
the  danger  of  impure  milk,  it  does  not  interfere  so  materi- 
ally with  its  normal  constituents. 

The  most  careful  attention  should  be  given  to  the  fre- 
quent cleaning  and  sterilization  of  cans  and  other  recep- 
tacles for  milk.  Indifference  to  this  important  detail  is  a 
common  means  by  which  infectious  diseases  are  trans- 
mitted. 

Both  brown  bread  and  eggs  represent  a  varied  diet,  and 
are  very  nutritious.  Fresh  eggs,  when  held  to  the  light, 
are  more  transparent  in  the  center,  and  stale  ones  at  the 
ends.  In  a  solution  of  one  part  of  salt  and  ten  of  water 
good  eggs  sink  and  bad  ones  float. 

Of  the  meats,  beef  has  the  greatest  nutritive  value,  and 
can  be  taken  indefinitely  without  becoming  unpalatable. 

Peas  and  beans  are  exceedingly  nourishing.  White 
bread  is  also  of  gi'eat  value  as  an  article  of  diet,  particu- 
larly so  when  combined  with  milk.  Sour  bread  may  be 
utilized  for  food  by  toasting,  as  heat  volatilizes  the  acid. 

Cheese  is  rich  in  nitrogen,  but  hard  to  keep,  and  decays 
rapidly.     Beef  extracts  and  juices  are  very  inferior  to 


HYGIENE.  207 

meats.  They  may  be  used  as  nutrients  and  stimulants  for 
a  short  time  ;  they  do  not,  however,  supply  tissue  waste. 

Potatoes  are  very  rich  in  starch,  contain  a  large  amount 
of  water,  and  vegetable  acids. 

Fresh  fruits  and  vegetables  are  of  great  value ;  they 
assist  in  regulating  the  assimilative  process,  and  act  as  a 
stimulus  to  the  gastro-intestinal  apparatus.  They  contain 
a  large  amount  of  vegetable  acids. 

Scorbutus  or  "  scurvy,"  an  exceedingly  disagreeable 
and  oftentimes  fatal  disease,  is  generally  attributed  to  the 
absence  from  the  diet  of  potatoes  and  other  vegetables  and 
fresh  fruit  which  contain  acids.  The  disease  is  more  com- 
monly seen  among  sailors  who  are  many  days  in  transit, 
and  who  are  deprived  of  the  above  articles  of  food  and 
restricted  to  a  diet  of  salt  meats.  This  disease  comes  on 
slowly,  with  a  feeling  of  general  debilitj^  and  mental 
apathy,  with  a  pale  yellowish  tint  of  skin,  and  insomnia  ; 
the  gums  become  soft,  and  bleed ;  the  breath  has  a  fetid 
odor.  There  are  also  pains  in  the  legs  which  may  simulate 
rheumatism,  great  prostration,  haemorrhage  from  different 
portions  of  the  body,  diarrhoea,  and  often  some  chest  affec- 
tion is  present.  The  treatment,  if  it  can  be  promptly  car- 
ried out,  is  very  effective ;  it  consists  mainly  in  supply- 
ing the  needed  dietary  articles,  combined  with  tonics,  etc. 
The  articles  of  food  which  are  used  as  a  preventive  as 
well  as  in  the  treatment  of  this  disease  are  known  as  "  an- 
tiscorbutics," and  comprise  fresh  fruits,  potatoes,  onions, 
cranberries,  pickled  cabbage,  lime  and  lemon  juice,  cheap 
light  wines  and  beers ;  raw  walrus  meat  is  highly  recom- 
mended. As  potatoes  contain  a  certain  amount  of  vege- 
table acids,  they  are  regarded  as  antiscorbutics.  Sugar, 
raisins,  currants,  yellow  mustard,  cresses,  dandelions,  and 
all  varieties  of  cactus  are  said  to  be  good.  Pemmican,  a 
mixture  of  dried  meat  pulverized  and  mixed  with  fat,  is 
generally  found  among  the  stores  of  an  arctic  explorer. 

It  is  of  great  importance  to  bear  in  mind  that  the  pre- 
vention of  scurvy  is  far  more  important  tha*i  its  treat- 


208  PROMPT   AID   TO   THE   IXJUPvED. 

ment,  inasmuch  as' those  affected  with  this  disease  are  at 
the  time  of  its  appearance  usually  where  they  are  unable 
to  secure  proper  treatment.  Therefore,  those  who  con- 
template being  a  long  time  away  from  centers  where 
proper  food  can  be  secured,  should  be  very  careful  to 
provide  themselves  with  such  supplies  as  are  known  to 
prevent  the  appearance  of  this  disease ;  these  can  now  be 
secured  in  a  compact  form  prepared  for  transportation 
and  change  of  climate. 

A  "  ration  "  represents  the  daily  allowance  of  food  for 
one  person. 

Water.  —An  adult  requires  about  70  to  100  ounces  of 
water  daily ;  20  to  30  ounces  of  this  is  contained  in  the  food. 

Horses  and  cattle  need  about  six  gallons  daily. 

The  water-supply  is  derived  from  rain-water,  springs, 
rivers,  lakes,  wells,  etc. 

Springs  are  the  outlets  of  underground  water,  and,  as  a 
rule,  give  a  pure  and  sparkling  stream,  the  character  of 
which  is  determined  by  the  composition  of  the  bed  from 
which  it  is  collected.  As  the  rain-water,  which  contains 
considerable  carbonic  acid,  passes  through  the  ground, 
more  or  less  change  takes  place,  dependent  upon  the  qual- 
ity of  the  strata  beneath.  Spring-water  is  frequently  rich 
in  the  salts  of  lime  and  magnesia.  The  presence  of  these 
salts  in  large  quantities  make  insoluble  compounds  with 
soap,  and  give  to  water  which  contains  them  the  name  of 
"hard  water."  Mineral  springs  are  caused  by  the  chem- 
ical change  which  takes  place  under  the  surface. 

Rain-water,  if  collected  in  the  country  and  upon  a 
proper  receiver,  is  pure,  whereas,  if  collected  in  cities  or 
towns  is  suspicious,  as  the  air  in  the  vicinity  of  these 
places  contains  large  quantities  of  organic  and  other  mat- 
ter which  is  injurious.  Rain-water  for  drinking  purposes 
should  not  be  collected  upon  the  roofs  of  houses  unless 
specially  prepared  ;  neither  are  the  ordinary  wooden  cis- 
terns the  proper  receptacles  for  rain-water  used  for  drink- 
ing ;  for  this  purpose  they  should  be  made  of  stone,  slate. 


HYGIENE.  201) 

or  other  similar  substances.  For  immediate  use  or  in 
emergencies  rain-water  may  be  collected  upon  pieces  of 
canvas  and  other  material  capable  of  holding  water.  Rain- 
water contains  a  comparatively  small  amount  of  the  lime 
and  magnesia  salts,  and  is  consequently  "soft  water." 

The  value  and  safety  of  river-water  for  drinking  pur- 
poses depends  upon  its  proximity  to  cities  and  large  towns 
and  the  sewerage  therefrom,  which  is  a  source  of  con- 
tamination ;  however,  considerable  of  this  matter  is  de- 
stroyed by  the  oxidation  combined  with  the  constant  mo- 
tion which  is  present.  The  numerous  fresh-water  plants 
also  cause  the  destruction  of  organic  matter.  River-water 
may  be  classed  as  a  "soft  water." 

Lake-water,  although  apparently  stagnant,  contains 
agents  which  keep  up  a  more  or  less  constant  motion. 
Among  these  are  the  numerous  springs  which  are  found 
in  the  bottom  of  the  lakes.  Considerable  of  the  organic 
matter  present  is  oxidized  by  the  sunlight  and  air,  and  the 
tranquillity  of  the  water  allows  a  large  amount  of  the 
organic  matter  to  be  precipitated.  The  vegetable  growth 
in  lakes  also  acts  as  purifiers,  consequently  water  taken 
from  a  large  lake  should  be  pure;  however,  water  from 
small  lakes  or  ponds  should  not  be  used  for  drink. 

Deep  wells  in  the  country  and  small  towns  constitute 
the  usual  means  of  securing  drinking-water  in  these 
places. 

Well-water  contains  considerable  lime  and  magnesia, 
and  is  consequently  more  or  less. hard.  While  deep  wells 
in  the  country  and  small  towns  represent  probably  the 
best  means  of  securing  a  good  and  wholesome  drinking- 
water,  it  must  be  remembered  that  they  should  not  be 
within  100  feet  of  any  privy,  cesspool,  or  other  means  of 
pollution,  which  will  soak  through  the  earth  for  a  long 
distance.  Typhoid  fever  in  the  country  is  commonly  con- 
tracted by  drinking  from  a  well  in  close  contact  with  a 
privy-vault  containing  the  discharge  of  persons  suffering 
from  this  disease.  Water  from  wells  in  cities  and  large 
15 


210  PROMPT    AID   TO   THE   INJURED. 

towns  should  never  be  used  for  drinking  purposes.  Boil- 
ing or  filtering  through  a  Pasteur  or  Berkefeld  filter  is 
the  only  sure  means  by  which  suspicious  water  can  be 
rendered  safe  for  drinking.  Boiling  is  simple  and  easily 
performed,  and  should  be  done  whenever  there  is  reason 
to  believe  that  the  water  may  be  polluted,  as  during  the 
prevalence  of  cholera  and  typhoid  fever.  Boiled  water 
is  more  or  less  flat,  resulting  from  the  removal  of  the  gas 
or  air  which  it  contains  by  the  action  of  the  heat.  It  may 
be  aerated  or  livened  up  by  agitating  in  an  open  churn,  or 
pouring  from  one  receptacle  to  another,  thus  entangling 
some  air,  which  makes  the  water  more  palatable.  Boiling 
usually  renders  water  somewhat  softer. 

A  simple  means  of  filtering  water  is  to  tie  a  piece  of 
double  thickness  canton  flannel  over  the  water  tap,  or 
over  a  receptacle,  and  allowing  the  water  to  pass  through 
it.     The  filter  should  be  frequently  changed. 

Turbid  water  can  be  cleaned  by  adding  five  or  ten 
grains  of  alum  to  a  gallon ;  then  boil  and  filter.  Other 
means  for  effecting  this  purpose  are  by  pieces  of  cactus- 
leaves,  or  five  or  six  grains  of  tannin  to  a  gallon,  exposure 
to  sun  and  air,  and  filtering  through  sand. 

Air. — Pure  air  is  essential  to  health;  the  different 
tissues  of  the  body  demand  an  uninterrupted  supply  of 
oxygen  for  their  maintenance ;  this  is  derived  from  the 
air,  the  composition  of  which  is  as  follows : 

In  100  parts — 

Oxygen,  20-96 ;  nitrogen,  78 ;  argon,  1 ;  carbonic 
acid,  '04. 

Ammonia,  ozone,  watery  vapor,  organic  matter,  and 
mineral  salts — traces. 

With  the  exception  of  the  latter  group,  the  relative 
proportions  of  the  different  ingredients  of  air  remain 
about  the  same  everywhere.  The  impurities  in  the  air 
are  derived  from  filthy  and  badly  ventilated  rooms  and 
buildings,  apartments  inhabited  by  unhealthy  persons 
and  those  suffering  from  contagious  diseases,  offensive 


HYGIENE.  211 

trades,  emanations  from  sewers,  cesspools,  marshes, 
mines,  etc.,  and  may  be  divided  into  suspended  and 
gaseous  matter.  The  former  includes  material  from  the 
animal  and  vegetable  world,  germs  of  disease,  etc. 
Among  the  gaseous  matter,  carbonic  acid  is  the  most  con- 
stant and  prominent ;  a  small  amount  of  this  gas  is  always 
present  in  what  may  be  called  pure  air,  and  represents 
about  "04  part  per  100.  It  is  the  increased  amount  of  this 
gas,  associated  with  organic  matter,  watery  vapor,  etc., 
which  is  responsible  for  the  uncomfortable  sensation 
experienced  in  public  gatherings,  improperly  ventilated 
schools,  etc.  Persons  subjected  to  continued  defective 
ventilation  suffer  from  depression,  headache,  gastric  dis- 
turbance, etc.,  and  are  particularly  susceptible  to  disease. 
The  increased  amount  of  carbonic  acid  in  the  air  in  large 
assemblages  is  derived  mainly  from  the  expired  air  of 
those  present ;  about  four  per  cent  of  the  oxygen  taken  in 
with  each  inspiration  is  appropriated  by  the  blood  passing 
through  the  lungs.  An  equal  amount  (four  per  cent)  of 
carbonic  acid,  representing  effete  or  worn-out  matter,  is 
thrown  off  in  the  expired  air,  and  is  unfit  for  respiration ; 
in  addition  to  the  carbonic  acid,  a  varying  amount  of 
watery  vapor  and  organic  matter  is  also  exhaled. 

In  an  overcrowded  room  wdth  improper  ventilation  the 
oxygen  becomes  rapidly  diminished  and  replaced  by  car- 
bonic acid;  this  change  may  not  be  noticed  until  some 
time  has  elapsed ;  the  air  of  the  room  becomes  offensive, 
and  those  present  feel  sleepy,  with  more  or  less  headache, 
and  embarrassment  of  respiration.  Among  the  more  ter- 
rible results  of  defective  ventilation  may  be  mentioned  the 
tragedy  that  occurred  in  Calcutta  about  the  middle  of  the 
last  century,  when  one  hundred  and  forty-six  English 
prisoners  were  thrown  into  the  jail  or  "Black  Hole"  of 
Calcutta.  This  consisted  of  a  room  about  eighteen  feet 
square,  with  two  small  windows  covered  with  iron  bars. 
The  prisoners  w^ere  put  in  this  apartment  in  the  latter  part 
of  tlie  day  or  evening,  and  when  the  door  was  opened  in 


212 


PROMPT   AID   TO   THE   INJURED. 


the  morning'  all  but  twenty-three  were  found  dead.  Some 
of  the  survivors  subsequently  died  as  the  result  of  this 
confinement. 

The  fresh  air  necessary  to  ventilate  an  apartment 
should  be  enough  to  destroy  all  sensible  odors  or  impu- 
rities which  would  result  from  imperfect  ventilation,  so 
that  a  person  coming  from  the  outside  should  from  the 
odor  appreciate  no  diflPerence  in  the  air. 

Apartments  occupied  by  the  sick  always  require  rela- 
tively more  fresh  air,  as  there  is  an  increased  exhalation 
from  the  skin  and  langs  containing  a  larger  amount  of 
organic  matter,  etc. 

An  increased  amount  of  fresh  air  is  also  needed  where 
artificial  light  is  used  (excepting  electricity),  as  this  method 
of  illumination  consumes  a  good  amount  of  oxygen.  Con- 
tamination of  the  air  may  also  occur  where  coal  is  used 
for  heating  purposes,  particularly  in  defective  stoves. 
Fu'eplaces  constitute  a  most  excellent  means  of  ventilat- 
ing a  room,  the  impure  air  being  drawn  up  the  chimney 
and  replaced  by  fresh  air  which  is  admitted  through  cracks 
under  doors,  etc.  The  vitiation  of  the  air  by  artificial  light 
is  shown  in  the  following  table  published  by  Notter  and 
Firth : 


Candle-power. 

Equivalent  vitiation  of 
atmosphere. 

Candles 

16 
16 

16 
50 

11-12  adults. 

Kerosene 

7      " 

Coal-gas 

Bat's- wing  burner  No.  5 . . . 
Welsbach  burner 

5      " 
3      " 

Electric  light  is  in  many  ways  superior  to  other  forms 
of  artificial  light,  inasmuch  as  it  consumes  no  oxygen, 
and  gives  ofp  no  product  of  combustion  by  which  the  air 
ma}^  become  polluted ;  it  also  gives  off  a  much  smaller 
amount  of  heat. 

At  least  four  or  five  hundred  cubic  feet  of  air  space 


HYGIENE.  213 

sliould  be  allowed  for  every  occupant  of  an  apartment. 
It  may  not  be  out  of  place  in  this  connection  to  speak 
of  the  importance  of  fresh  air  where  cases  of  plithisis  or 
tuberculosis  (consumption)  exist.  It  is  now  known  that 
this  disease  is  due  to  a  special  germ  or  bacillus  which  is 
present  in  large  numbers  in  the  expectoration  or  sputum  ; 
the  latter  becomes  dried  and  diffused  as  dust  in  the  air, 
and  by  being  inhaled  may  infect  other  persons,  particu 
larly  those  who  are  in  close  and  continued  contact  with 
the  patient.  In  other  words,  consumption  is  due  to  the 
reception  of  the  tubercle  bacilli  communicated  from  one 
infected  with  the  disease  to  another,  and  can  be  prevented 
if  the  proper  precautions  are  taken  (see  Disinfection). 

Exercise. — Organs  and  muscles  which  do  not  receive 
the  proper  exercise  become  smaller,  or  undergo  what  is 
known  as  "atrophy."  Therefore  exercise  of  all  portions 
of  the  body  is  necessary.  Insufficient  exercise  favors  the 
accumulation  of  carbon  in  the  system,  with  the  conse- 
quent bad  results.  Those  who  follow  sedentary  habits 
and  are  confined  at  desks,  etc.,  are  prone  to  chest  troubles 
from  diminished  lung  capacity. 

Work  in  a  gymnasium,  etc.,  does  not  represent  the 
exercise  essential  to  health.  It  should  be  in  the  open  air, 
and  not  too  violent.  Golf  and  horse-back  riding,  particu- 
larly the  former,  are  valuable  means  of  exercise  combined 
with  pleasure,  the  latter  being  an  important  consideration. 
In  the  selection  of  exercise,  golf-playing  or  walking  may 
be  considered  as  the  best  method  by  which  the  different 
portions  of  the  body  may  be  properly  exercised.  It  has 
been  estimated  that  a  walk  of  ten  miles  distributed  over 
the  day  is  about  the  proper  amount  of  exercise  which 
should  be  taken  by  a  healthy  adult  in  twenty-four  hours. 
This  is  said  to  be  equivalent  to  lifting  one  hundred  and 
fifty  tons  one  foot  from  the  ground  daily.  Too  much 
or  too  violent  exercise  is  injurious,  particularly  in  the 
weak  and  delicate. 


CHAPTEE   XX. 

DISIFFEGTION. 

A  DiSDs'FECTAXT  is  an  agent  which  destroys  infectious 
material.  This  term  as  a  rule  is  loosely  applied,  and  is 
frequently  confounded  with  deodorants, — which  are  not 
necessarily  disinfectants,  but  simply  neutralize  ofiensive 
odors, — and  with  antiseptics,  which  inhibits  or  holds  in 
cheek  the  propagation  of  infectious  germs  without  always 
destroying  them.  Innumerable  articles,  proprietary  and 
otherwise,  are  advertised  or  recommended  as  disinfectants. 
These  are  frequently  worthless,  and  it  should  be  accepted 
as  a  rule  that  no  article  or  mixture  recommended  for  dis- 
infection is  entitled  to  any  consideration  unless  its  com- 
position is  fully  known.  The  number  of  agents  at  present 
employed  in  scientific  disinfection  is  limited,  and  is  gen- 
erally confined  to  heat,  sulphur  dioxide,  formaldehyde,  bi- 
chloride of  mercury,  carbolic  acid,  and  preparations  of 
lime.  Even  a  brief  description  of  this  subject  is  incom- 
plete without  a  reference  to  Nature's  disinfectants — air 
and  sunlight — ^the  value  of  which  has  been  fully  proven 
by  bacteriological  research  and  practical  experience.  Al- 
though their  germicidal  action  is  not  rapid  they  are  al- 
ways available — a  very  important  consideration.  Were  it 
not  for  the  protection  which  Nature  gives  us  in  this 
way,  our  effort  to  prevent  the  extension  of  infectious  dis- 
eases would  meet  with  doubtful  success.  The  importance 
of  this,  as  well  as  the  great  value  of  cleanliness,  must 
always  be  borne  in  mind  in  the  care  of  infectious  diseases. 

Of  the  disinfectants  which  it  is  within  our  power  to 
create,  steam  is  the  most  valuable  for  the  treatment  of 


DISINFECTION.  215 

clothing:,  bedding,  and  other  textile  fabrics,  both  on  ac- 
count of  its  prompt  germicidal  action  and  the  power  of 
deep  penetration  which  it  possesses.  The  uncertainty 
which  has  heretofore  existed  as  to  the  temperature  of  moist 
heat  and  the  exposure  necessary  to  kill  micro-organisms 
has  been  practically  removed  by  the  result  of  recent  scien- 
tific experiments,*  which  have  shown  that  a  temperature  of 
230°  Fahr.  for  a  period  of  fifteen  minutes  will  kill  all 
known  pathogenic  organisms  (germs  which  cause  infec- 
tious disease),  even  in  the  center  of  large  bundles  tightly 
packed.  Steam  destroys  goods  composed  of  leather,  rubber 
material  stiffened  with  glue,  etc.,  etc.,  and  is  apt  to  injure 
silks  and  other  fine  fabrics.  Clothing,  bedding,  etc.,  are 
as  a  rule  unharmed.  Unfortunately  the  apparatus  neces- 
sary for  steam  disinfection,  which  is  more  or  less  compli- 
cated and  expensive,  has  thus  far  been  available  only  in 
cities.  However,. as  the  value  of  this  agent  is  now  better 
known,  there  is  good  reason  to  believe  that  a  steam  disin- 
fecting chamber  will  soon  be  found  in  every  community 
for  public  disinfection. 

Boiling  Water. — What  is  more  often  required  are 
means  by  which  thorough  disinfection  may  be  performed 
in  the  household  or  in  emergencies.  For  this  purpose  boil- 
ing water  constitutes  one  of  the  most  effective  and  prac- 
tical disinfectants  known.  It  is  certain  in  its  action, 
costs  nothing,  is  harmless,  and  an  apparatus  for  its  prep- 
aration can  always  be  improvised.  It  is  only  re- 
quired that  there  shall  be  a  metal  receptacle  in  which  the 
water  may  be  boiled  and  that  the  material  treated  shall 
be  continuously  boiled  for  twenty  minutes.  This  is  im- 
perative, and,  unless  it  is  properly  carried  out,  disinfec- 
tion cannot  be  depended  upon.  Simply  placing  articles  in 
boiling  water  and  allowing  it  to  cool  does  not  insure  disin- 
fection. The  range  of  usefulness  of  boiling  water  is  very 
great.  It  is  more  commonly  used  for  household  linen, 
china,  glassware,  kitchen  utensils,  cutlery,  etc.,  also  dis- 
*  Doty,  American  Journal  of  the  Medical  Sciences,  August,  1897. 


216  PROMPT  AID  TO  THE  INJURED. 

charges,  dressings,  and,  in  fact,  anything  which  may  be 
immersed  in  this  agent.  It  is  well  known  that  boiling 
water  usually  shrinks  woolen  goods.  This  should  not  be 
considered  if  it  is  required  that  the  material  be  disin- 
fected, provided  steam  disinfection  is  not  available. 

Sulphurous  Acid  Gas  (sulphur  dioxide)  is  the  oldest 
known  disinfectant,  and  is  generated  by  burning  ordinary 
sulphur.  Although  we  are  not  yet  in  possession  of  such 
definite  scientific  facts  relative  to  the  value  of  sulphur 
dioxide  as  bacteriological  research  has  given  us  regard- 
ing steam,  recent  investigation  has  shown  that  sulphur 
dioxide  is  a  germicidal  agent  provided  moisture  is  pres- 
ent. In  the  summer,  when  considerable  humidity  exists, 
sufficient  moisture  necessary  to  render  this  gas  effective 
is  probably  present.  However,  in  the  winter,  when 
apartments  are  kept  closed  and  heated,  and  become  dry, 
a  small  amount  of  moisture  should  be  supplied  before 
the  sulphur  is  ignited.  This  may  be  done  by  generating 
steam  in  some  simple  way.  The  ordinary  sulphur  which 
is  used  for  the  manufacture  of  this  gas  is  always  avail- 
able even  in  very  small  towns,  and  an  effective  apparatus 
for  burning  it  can  easily  be  improvised  in  the  following 
manner :  On  the  bottom  of  an  ordinary  washtub  are  placed 
two  or  three  bricks  to  support  a  metallic  receptacle  in  the 
shape  of  an  ordinary  milk  pan,  or  a  galvanized-iron  wash 
basin,  etc.  The  tub  should  be  filled  with  water  to  a 
height  above  the  bricks  and  the  bottom  of  the  pan.  This 
prevents  the  burning  of  the  floor  of  the  apartment  and  bot- 
tom of  the  receptacle;  besides,  by  this  arrangement  the 
spluttering  of  the  burning  sulphur  causes  no  damage.  If 
a  washtub  is  not  available,  a  metallic  pail  containing  the 
sulphur  can  be  placed  in  another  partly  filled  with  water : 
the  same  protection  is  thus  afforded.  The  capacity  of  the 
apartment  to  be  disinfected  should  be  ascertained,  and  for 
every  thousand  cubic  feet  of  space,  four  pounds  of  sulphur 
should  be  burned.  The  sulphur  should  be  broken  in  small 
pieces  before  placing  in  the  pan  or  pail  referred  to.     If 


DISINFECTION.  217 

the  room  is  large,  it  is  better  to  have  more  than  one  re- 
ceptacle in  order  that  the  sulphur  can  be  easier  exposed  to 
the  air,  and  the  gas  more  evenly  diffused.  If  possible, 
the  sulphur  should  be  ignited  by  carefully  pouring  alcohol 
over  the  mass,  upon  which  is  dropped  a  lighted  match  or 
piece  of  paper,  the  operator  at  the  time  standing  as  far 
from  the  receptacle  as  possible.  If  alcohol  can  not  be  ob- 
tained, a  lighted  coal  may  be  placed  in  the  mass  of  sul- 
phur, although  this  does  not  as  a  rule  insure  satisfactory 
or  complete  combustion.  The  apartment  should  be  closed 
for  at  least  six  hours.  Before  the  gas  is  generated  (this 
also  applies  to  the  use  of  formaldehyde)  care  should  be 
taken  that  all  windows  and  other  openings  are  tightly 
closed  and  sealed.  The  latter  can  be  accomplished  by  the 
use  of  slips  of  newspapers  about  two  inches  wide  made 
fast  with  common  flour  paste.  These  are  afterward  easily 
removed.  The  most  careful  attention  should  be  given  to 
these  details. 

Formaldehyde  Gas,  which  is  generated  by  the  imper- 
fect combustion  of  wood  or  methyl  alcohol,  was  acciden- 
tally discovered  in  1868  by  Hoffman,  a  German  chemist. 
It  was  not,  however,  until  twenty  years  afterward  that  the 
attention  of  the  medical  profession  was  called  to  its  value 
as  a  disinfectant.  Since  that  period  this  agent  has  been 
exhaustively  investigated,  and  its  germicidal  value  estab- 
lished. Formerly  its  employment  required  a  complicated 
apparatus,  which  was  manufactured  by  different  instru- 
ment makers ;  however,  it  may  now  be  generated  by  adding 
to  one  pound  of  unslaked  lime  eight  ounces  of  a  commer- 
cial product  known  as  formalin  for  every  1,000  cubic  feet 
of  space  to  be  disinfected.  This  may  be  generated  in  any 
spacious  metallic  receptacle.  In  comparing  the  value  of 
sulphur  dioxide  and  formaldehyde,  it  may  be  said  that 
while  sulphur  dioxide  and  formaldehyde  are  equally  good 
germicidal  agents,  sulphur  bleaches  and  otherwise  injures 
certain  fabrics,  such  as  colored  silks,  satins,  wall  paper, 
gilded  articles,  etc.,  although  the  ordinary  woolen  and  cot- 


218  PROMPT  AID  TO  THE  INJURED. 

ton  wearing  apparel,  etc.,  is  not  affected;  whereas  these 
articles  can  be  subjected  to  formaldehyde  without  injury. 
It  may  be  said  that  in  the  disinfection  of  apartments  con- 
taining gilt  or  colored  paper,  delicate  hangings,  etc.,  it  is 
better  to  use  formaldehyde;  whereas,  in  schoolhouses  and 
apartments  where  valuable  decorations  are  not  present, 
sulphur  is  equally  good  and  more  easily  employed.  Fur- 
thermore, sulphur  is  promptly  destructive  to  rats  and 
other  vermin,  and  insects,  whereas  formaldehyde  can  not 
be  depended  upon  for  this  purpose. 

In  the  use  of  gaseous  disinfectants  such  as  sulphur 
and  formaldehyde  it  must  be  distinctly  understood  that 
while  they  are  serviceable  for  superficial  disinfection,  they 
can  not  he  depended  upon  to  penetrate.  Therefore  mate- 
rial presented  for  disinfection  which  can  not  preferably 
be  treated  with  steam  or  boiling  water  should  be  opened 
and  carefully  spread  out  in  order  that  all  surfaces  are 
exposed.  Mattresses  which  are  soiled  with  discharges 
should  be  burned,  if  steam  disinfection  is  not  available. 

The  use  of  gaseous  disinfectants  such  as  sulphur  di- 
oxide and  formaldehyde  is  commonly  and  improperly  re- 
ferred to  as  fumigation. 

Bichloride  of  Mercury  (corrosive  sublimate). — This 
substance,  which  occurs  in  the  form  of  white  crystals,  is  a 
powerful  germicide,  and  is  very  largely  used  as  a  disin- 
fectant, always  in  the  form  of  a  solution.  Corrosive  sub- 
limate is  exceedingly  poisonous  when  taken  internally. 
If  a  solution  of  this  agent  is  prepared  for  disinfection  and 
is  not  immediately  used,  it  should  be  colored  for  identifi- 
cation, inasmuch  as  the  solution  has  no  odor  or  color,  and 
may  be  mistaken  for  something  else.  For  this  purpose 
five  grains  of  f uchsin  or  permanganate  of  potassium  may 
be  added  to  each  gallon.  The  receptacle  in  which  it  is  con- 
tained should  be  conspicuously  labeled  "POISON,"  be- 
sides something  to  indicate  the  strength  of  the  solution. 
Fortunately  this  agent  is  very  cheap  (less  than  one  dollar 
per  pound),  and  a  gallon  of  a  1-1,000  solution  can  be  made 


DISINFECTION.  219 

for  one  cent.  Therefore  on  the  ground  of  economy  no 
excuse  can  be  offered  for  the  use  of  proprietary  solutions, 
the  composition  and  strength  of  which  are  unknown. 
Corrosive  sublimate  is  decomposed  by  copper,  tin,  lead, 
etc.;  consequently,  solutions  of  this  agent  should  not  be 
prepared  or  kept  in  metallic  receptacles,  but  in  glass, 
porcelain,  or  wooden  vessels.  A  solution  of  bichloride  for 
general  use  in  disinfection  is  prepared  as  follows :  Bichlo- 
ride of  mercury,  one  drachm  (sixty  grains)  ;  common  salts, 
two  tablespoonfuls  dissolved  in  one  gallon  of  hot  water 
(constituting  a  1-1,000  solution).  This  may  be  diluted 
with  water  when  weaker  solutions  are  called  for. 

Carbolic  acid,  a  very  valuable  disinfectant,  but  not 
equal  to  corrosive  sublimate  in  germicidal  power,  although 
more  generally  used  for  the  disinfection  of  excreta,  inas- 
much as  it  is  believed  to  more  readily  penetrate  this  sub- 
stance. Its  odor  is  well  known,  and  in  the  pure  state  it 
usually  appears  as  a  white  crystallized  substance,  which 
becomes  liquid  at  a  temperature  of  95°  F.  For  general 
disinfection,  dissolve  six  ounces  in  one  gallon  of  hot  water. 
This  practically  makes  a  five-per-cent  solution,  which  may 
be  diluted  (see  Special  Disinfection).  The  colored  im- 
pure carbolic  acid  should  not  be  used  for  this  purpose. 
Great  care  should  be  taken  not  to  let  the  undiluted  car- 
bolic acid  come  in  contact  with  the  skin,  which  it  vio- 
lently attacks.  The  extremely  poisonous  character  of  bi- 
chloride of  mercury  and  carbolic  acid  should  not  be  for- 
gotten.    (See  Poisons.) 

Milk  of  lime,  made  by  adding  one  quart  of  freshly 
slaked  lime  to  four  or  five  quarts  of  water.  Air-slaked 
lime  should  not  be  used  as  a  disinfectant. 

Chloride  of  Lime. — An  agent  in  common  use.  Chlo- 
ride of  lime,  to  preserve  its  value  as  a  disinfectant,  should 
be  kept  in  tightly  closed  packages. 


220  PROMPT  AID  TO    THE  INJURED. 

SPECIAL  DISINFECTION. 

Apartments,  bedding,  clothing,  etc.  (See  Steam,  Boil- 
ing Water,  Sulphur  Dioxide^  and  Formaldehyde. 

Tlie  Hands. — The  hands,  after  having  been  in  contact 
with  persons  sick  with  infectious  diseases,  should  be  im- 
mersed in  a  1-1,000  solution  of  bichloride  or  a  two-per- 
cent solution  of  carbolic  acid  for  a  short  time  and  after- 
ward thoroughly  scrubbed  in  soap  and  hot  water  with  a 
brush :  this  applies  particularly  to  the  nails. 

Textile  Fahrics. — ^Linen  and  cotton  material  such  as 
handkerchiefs,  napkins,  sheets,  etc.,  which  are  too  valu- 
able to  be  burned,  and  which  can  not  be  subjected  to 
steam,  should  be  kept  in  boiling  water  for  at  least  fifteen 
minutes,  or  kept  in  a  1-2,000  solution  of  bichloride  or 
a  five-per-cent  solution  of  carbolic  for  at  least  two  hours, 
and  afterward  washed  out  in  water.  As  already  stated, 
bichloride  solutions  should  not  be  put  in  metal  vessels,  as 
the  solution  is  not  only  decomposed,  but  the  material  to 
be  disinfected  is  stained. 

Excreta  and  other  discharges  may  be  disinfected  by 
the  free  use  of  chloride  of  lime  in  the  proportion  of  four 
to  eight  ounces  of  the  lime  to  a  gallon  of  water,  according 
to  the  consistence  of  the  discharge,  or  with  milk  of  lime, 
or  a  five-per-cent  solution  of  carbolic  acid  or  bichloride 
(1-1,000) — the  disinfecting  solution  should  equal  twice 
the  amount  of  discharge.  The  sputum  from  patients  suf- 
fering from  consumption  (tuberculosis)  should  be  re- 
ceived in  covered  cups  containing  one  of  the  preparations 
just  referred  to.  However,  boiling  water  when  practicable 
is  far  superior  for  the  disinfection  of  the  above  material. 

Cess-pools,  drains,  stables,  urinals,  privy-vaults,  cel- 
lars, spaces  under  refrigerators,  etc.,  should  be  disinfected 
by  the  use  of  chloride  of  lime  or  milk  of  lime  freely  used. 
These  agents,  besides  their  germicidal  power,  are  de- 
odorants. For  this  reason  cellars,  air-shafts,  etc.,  should 
be  frequently  whitewashed,  which  constitutes  an  efficient 


DISINFECTION.  221 

superficial  disinfectant;  the  use  of  carbolic  acid  in  these 
instances  leaves  the  peculiar  odor  of  this  agent,  which  is 
not  always  agreeable;  besides,  carbolic  acid  is  far  more 
expensive  and  dangerous  than  lime. 

Knives,  forks,  spoons,  and  other  metal  implements, 
dishes,  etc.,  should  preferably  be  disinfected  by  boiling 
or  may  be  treated  by  immersion  in  a  five-per-cent  solution 
of  carbolic  acid  for  two  hours,  afterward  washed  with  hot 
water  and  soap. 

Some  infectious  diseases,  such  as  typhoid  fever  and 
cholera,  are  communicated  through  the  medium  of  food 
and  drink  receptacles,  etc.,  which  have  become  contam- 
inated by  the  discharges  of  persons  suffering  from  these 
diseases.  Therefore  during  the  prevalence  of  the  latter  all 
fluids  taken  for  drink  should  be  boiled  and  the  food  thor- 
oughly cooked.  Uncooked  fruit,  vegetables,  etc.,  should  be 
avoided. 

In  the  treatment  of  dead  bodies  such  as  are  recovered 
from  fires,  accidents,  etc.,  particularly  where  decomposi- 
tion has  ensued,  and  filthy  cess-pools,  drains,  etc.,  occurring 
in  the  summer,  the  employment  of  a  deodorant  is  urgently 
called  for.  For  this  purpose  no  more  effective  agent  than 
a  combination  of  lime  and  copper,  one  pound  each  of  un- 
slaked lime  and  sulphate  of  copper  (blue  vitriol)  added  to 
and  dissolved  in  10  gallons  of  water,  which  constitutes  the 
most  practical  and  simple  deodorant  in  use,  bromine, 
which  is  purchased  in  sealed  bottles,  and  in  appearance 
resembles  tincture  of  iodine,  may  be  used;  however,  this 
is  poisonous  and  dangerously  irritating  to  the  respiratory 
tract,  and  should  be  used  with  the  greatest  caution;  the 
bottle  should  not  be  opened,  but  broken  under  water  with 
a  crowbar  or  poker.  In  making  the  solution,  about  four 
ounces  of  bromine  to  a  hogshead  containing  two  hundred 
gallons  is  sufficient  for  general  use.  After  the  bromine 
has  been  thoroughly  mixed,  it  can  be  distributed  over  the 
decomposed  organic  matter  by  the  ordinary  garden 
sprinkling  pot,  in  the  same  manner  that  the  solution  of 


222  PROMPT  AID  TO  THE  INJURED. 

lime  and  copper  is  used;  however,  it  is  far  inferior  to  the 
latter  combination,  and  dangerous  and  more  expensive. 

Open  wounds  may  be  washed  out  with  a  1-5,000  solu- 
tion of  bichloride  of  mercury  or  a  one-per-cent  solution  of 
carbolic  acid. 

If  the  disinfectants  which  have  already  been  referred 
to  are  not  available,  it  must  be  remembered  that  fresh  air, 
sunlight,  and  cleanliness  are  extremely  valuable  agents  in 
preventing  the  extension  of  disease  and  abating  offensive 
odors,  and  should  be  made  use  of  to  the  fullest  extent. 

The  bodies  of  those  dying  of  infectious  diseases  should 
be  wrapped  in  a  sheet  soaked  in  a  five-per-cent  solution  of 
carbolic  acid  or  a  1-1,000  solution  of  bichloride  of  mer- 
cury, preferably  the  latter,  and  then  be  placed  in  a  recep- 
tacle, which  is  afterward  hermetically  sealed. 

The  different  forms  of  antiseptic  material  (gauze,  etc.) 
are  made  by  treating  tarlatan,  absorbent  cotton,  and  other 
fabrics  with  a  disinfectant  solution.  These  are  found  in 
the  shops  in  compact  form,  and  should  be  kept  in  her- 
metically sealed  glass  jars  and  other  proper  receptacles 
until  used,  otherwise  their  value  soon  becomes  impaired. 
Attention  must  again  be  called  to  the  fact  that  steam  and 
boiling  water  are  superior  to  all  other  disinfectants  and 
should  be  employed  whenever  it  is  practical  to  do  so. 


INDEX. 


Acetic    acid,    poisoning    by,    187. 
Acids,    poisoning   by,    187. 
Aconite,   poisoning  by,    185. 
"  Adam's  apple,"   39. 
Air  cells,  or  vesicles,  41. 
Air,  quantity  of,   respired,  43. 
Alcohol,    poisoning   by,    186. 
Alimentation,    4.5. 
Alkalies,   poisoning   by,    188, 
Ammonia,   poisoning  by,   188. 
Antiseptics,   91,   221.  - 
Aponeurosis,    27. 
Apoplexy,    15.5. 

heat,    160. 

treatment  of,   157. 
Arm -bone,  or  humerus,  14. 
Arm   slings,   81. 
Arsenic,   174. 

poisoning   by,    183. 
Arteries,    anatomy   of,    36. 

nutrient,   3. 
Artificial   respiration,    167. 

Hall's  method,  170. 

Howard's    method,    169. 

Sylvester's  method,   167. 
Asphyxia,    164. 

precautions  in  rescuing,  164. 

treatment   of,    164. 
Atropine,    173. 

poisoning  by,   180. 
Axillary    artery,    compression    of, 
113, 

Bandages,   68. 

application    of,    69,    71. 
circular,   70. 
cravat,   83. 
double-headed    knotted,    73. 


Bandages,  Esmarch  or  triangular, 
76. 

Esmarch,      a      triangular,      for 
chest,    79. 

for    foot,    83. 

for  hand,   78. 

for   head,   78. 

for  hip,  82. 

for    shoulder,    78. 

figure-of-8,    71. 

four-tailed,   74. 

head,   73. 

hip  spica,  72. 

large,    square    handkerchief   for 
head,   76. 

materials  for,   68. 

method   of   roiling,    69. 

roller,  68. 

shoulder   spica,    73. 

six-tailed,    75. 

sling,   81. 

spiral  reverse,   70. 

triangular,   76. 
Basin,    the,   or   pelvis,    18. 
Bed-sores,    102. 
Belladonna,  173. 

poisoning   by,    180. 
Bladder,    urinary,    55. 
Blood,   30. 

amount  of,  in  human  body,  31. 

arterial,   31,   35. 

circulation  of,   34. 

coagulation    of,    31. 

composition,   30. 

corpuscles,   30. 

venous,   31,   34, 

vessels,   anatomy  of,  36. 
Bone,   cancellous   tissue,   2. 

223 


224 


PROMPT  AID  TO  THE  INJURED. 


Bone,   compact  tissue,  2. 

composition   of,    1. 

hyoid,  10. 

innominate,    19. 

marrow    of,    3. 

necrosis   of,   3. 

oil   of,   3. 

spongy  tissue,  2, 
Bones,   classification  of,   4. 
Bony    landmarks,    artificial,    7. 
Brachial    artery,    compression    of, 

114. 
Brain,    59. 

compression    of,    155. 

concussion    of,    154. 

weight    of,    63. 
Brandy,    99,    110,    173. 
Bread   poultices,   89. 
Breast-bone,    or    sternum,    11. 
Bromine,   solution   of,   221. 
Bronchial  tubes,   41. 
Bruises,   91. 
Burns,    140. 

constitutional  treatment  of,  143. 

of    first    degree,    140. 
treatment  of,   140. 

of  second  degree,   140,   141. 
treatment  of,    141. 

of  third  degree,  140,   142. 
treatment  of,  142. 

Camphor,   poisoning  by,    180. 
Cantharides,   poisoning  by,   184. 
Capillaries,  anatomy  of,  37. 
Carbolic  acid,   or  phenol,   218. 

poisoning  by,   187. 
Carpus,    or    wrist,    18. 
Cartilage,  or  gristle,  24. 
Catching   fire,    143. 
Caustic  potash,  poisoning  by,  188. 
Caustic    soda,    poisoning    by,    188. 
Cerebellum,    62. 
Cerebro-spinal  system,  59. 
Cerebrum,    61. 
Chafing,    195. 
Chest,  or  thorax,  10. 

bandages,  79. 
Chloral,    174. 

poisoning  by,   181. 


Chloroform,   poisoning  by,   181. 

Clavicle,  or  collar-bone,   12. 

Colic,  kidney,   55. 

Collapse,    147. 

Collar-bone,   or  clavicle,    12. 

fracture   of,    129. 
Common  carotid  artery,   compres- 
sion of,   112. 
Compresses,   86. 

Compression    of    axillary    artery, 
113. 

of   brachial   artery,   114. 

of   brain,    154. 

treatment  of,   155. 

of  common  carotid  artery,   112. 

of   femoral   artery,    116. 

of  popliteal  artery,  116. 

of    radial    and    ulnar    arteries, 
115. 

of  subclavian  artery,  112. 
Concussion    of    the    brain,    154. 

treatment  of,   154. 
Contusions,    91. 
Convulsions   of   children,    189. 
Copper,    poisoning   by,    184. 
Corn-meal  poultices,   89. 
Corrosive    sublimate,    or    bichlor- 
ide   of    mercury,    218. 

poisoning  by,   188. 
Cranial    bones,    fracture    of,    126. 
Cravat   bandages,    83. 
Creasote,    poisoning   by,    187. 
Croton-oil,   poisoning  by,    184. 
Cuticle,   56. 

Deodorants,   98. 

Derma,    or    true    skin,    57. 

Diaphragm,   42. 

Digestion,   45. 

Digitalis,    poisoning    by,    189. 

Diploe,    2. 

Disinfectants,    214. 

bichloride   solution,   218. 

boiling   water,    215. 

carbolic-acid    solution,    218. 

dry  chloride  of  lime,  219. 

formaldehyde    gas,    216. 

milk   of   lime,   219. 

steam,    215. 


INDEX. 


225 


Disinfectants,      sulphurous      acid 

gas,  215. 
Disinfection,  metliods  of  effecting, 

214. 
of  closets  and  sinks,  220. 
of    clothing,    towels,    etc.,    219. 
of   dead    Ixidy,    221. 
of    discharges,    220. 
of  dishes,   knives,   etc.,   220. 
of  food   and   drink,   220. 
of  hands  and  person,  219. 
of  rags,  cloths,  etc.,   219. 
of  rooms  and  contents,  214. 
of   sputum    from    consumptives, 

220. 
Dislocations,   137. 
of  humerus,    137. 
of  lower  jaw,   138. 
of  phalanges,    138. 
Dog-bite,  treatment  of,  99. 
Drowning,    165. 
treatment   of,   166'. 

Hall's   method,    170. 

Howard's   method,    169. 

Sylvester's    method,    167. 

Ear,  foreign  bodies  in,  191. 
Emetics,  177. 
Endocardium,  36. 
Endosteum,  4. 
Epidermis,  56. 
Epiglottis,  39. 
Epilepsy,    158. 

treatment  of,   158. 
Epistaxis,    or   nose-bleed,    110. 
Excretion,   29. 
Eye,  foreign  bodies  in,  190. 

Fainting,    151. 

treatment  of,  152. 
Falling-sickness,  158. 
Femoral    artery,    compression    of, 

116. 
Femur,    the,   or   thigh-bone,    19. 

fractures  of,   132, 
Fever,   sun,   160. 
Fibula,   the,   or  splint-bone,   22. 

fractures  of.   135. 
16 


Fingers,  dislocation  of,   138. 

fractures  of,   l.*{2. 
Fits,   epileptic,   158. 
Flaxseed    poultices,    88. 
Fontanelles,    the,    9. 
Food,    201-208. 
Foot    bandages,    83. 
Foot-soreness,    195. 
Forearm,    fractures   of,    130. 
Foreign  bodies  in  ear,  191. 
in   eye,    190. 
in   larynx,   193. 
in  nose,   192. 
in   pharynx,    193. 
Formaldehyde,    as   a   disinfectant, 

216. 
Fractures,   120. 

classification   of,    120. 
diagnosis    of,    121. 
of    clavicle,    129. 

treatment  of,  129. 
of  cranial  bones,  126. 
of    femur,    132. 

treatment   of,   133. 
of   forearm,    130. 

treatment  of,   131. 
of  forearm,   middle  of,   131. 

treatment   of,    131. 
of  humerus,    130, 

treatment  of,   130. 
of      inferior      maxillary      bone, 

126. 
of    leg,    135. 

treatment  of,    136. 
of  metacarpal  bones,   131, 

treatment  of,   132. 
of    metatarsal    bones,    137. 
of   patella,    136. 

treatment  of,   137. 
of    phalanges    of    fingers,    132. 
of    ribs,    127. 

treatment  of,    128. 
of  scapula,   130. 

treatment   of,   130. 
of    spinal    column,    127. 

treatment   of,   127. 
of  tibia  and  fibula,   135. 
of    toes,    137. 
of    vertebral    column,    127. 


226 


PROMPT  AID  TO  THE  INJURED. 


Fractures,    splints   for,    124. 

treatment  of,  122. 
Frost-bite,   144. 

treatment  of,  153. 
"  Funny-bone,"   18. 

Gangrene,   101. 

treatment   of,   102. 
Gastric  juice,   function  of,  49. 
Gland,   definition  of,   29. 
Glands,    salivary,    47. 

sweat,   57. 
Gravel,    54. 

Gristle,  or  cartilage,  24. 
Gullet,  or  oesophagus,  47. 

Haematemesis,       or      haemorrhage 

from  stomach,  119. 
Haemoptysis,      or      '•  spitting      of 

blood,"  118. 
Haemorrhage,  arrest  of,  104. 

arterial,    105. 

capillary,    109. 

classification    of,    104. 

from  axillary  artery,   114. 

from   brachial    artery,    114. 

from    common    carotid    artery, 
112. 

from  femoral  artery,   116. 

from    lips,    110. 

from  mouth,   110. 

from   popliteal   artery,    116. 

from  radial  artery,   115. 

from   scalp,    110. 

from   subclavian  artery,   112. 

from  ulnar   artery,    115. 

nasal,     110. 

secondary,    116. 

symptoms   of,    117. 

treatment    of,    118. 

after  extraction  of  teeth,  110. 

venous,    108. 
Hair-follicles,   57. 
Hand   bandages,    78. 
"  Haunch,"    or    innominate    bone, 

19. 
Head    bandages,    78. 
Heart,    32. 

anatomy  of.   33. 


Heart,  power  of,  36. 
Heat,   dry,   application  of,   90. 
moist,    application    of,    90. 
Heatstroke,    160. 
Hip    bandages,    82. 
Hominy    poultices,    89. 
Humerus,    or   arm-bone,    14. 
Hydrocyanic    acid,    poisoning    by, 

182. 

Hygiene,   197. 

air,    210. 

effects  of  bad,   211. 
baths,   197. 

addition   to,   of   alcohol,   etc., 

198. 
cold,    197. 

Russian   or  Turkish,   198. 
sea,    198. 
warm,    198. 
clothing,       silk,       cotton,      and 
linen,  200. 
woolen,    199. 
dandruff,    199. 
exercise,    213. 
food,   201. 

constituents    of,    202-207. 
scurvy,  207. 
skin,    activity    of,    197. 
soap,    the   use   of,    199. 
water,  208. 

amount    required    daily,    208. 
lake,   209. 
rain,   208. 
spring,    208. 
well,    209. 
Hyoid   bone,   10. 
Hypodermic  medication,   172. 
Hysteria,    159. 

treatment  of,    159. 
Hysterics,    159. 

Inferior    maxillary    bone,     dislo- 
cation   of,    138. 
fracture    of,    126. 
Innominate,    or    "  haunch  "    bone, 

10. 
Instep,  or  tarsus,  22. 
Integument,  or  skin,   56. 
appendages    of,    57. 


INDEX. 


227 


Integument,   care  of,   57,   107. 

functions   of,   57. 
Intestine,   large.   50. 

small,   40. 
Intoxication,    157. 

treatment   of,    157. 
Iodine,  poisoning  by,  185. 
Irritant   poisons,    183. 

Joints,    classification   of,    23. 
composition  of,  24. 
movements  of,   28. 

Kidney   colic,   55. 
Kidneys,    54, 
Knee-cap,  or  patella,  22. 
Knots,    85. 

Landmarks,    superficial    bony,    7. 
Larynx,   39. 

foreign    bodies    in,    193. 
Laudanum,     poisoning     by,     173, 

183. 
Ligaments,    24. 

Lime,   as   a   disinfectant,    219. 
Lips,   hemorrhage   of,   110. 
Liver,   51. 

functions   of,    52. 
Lower   jaw,   dislocation   of,    138. 

fracture   of,    126. 
Lungs,   42. 

capacity  of,   44. 
Lye,    poisoning  by,   188. 
Lymphatics,   4. 

Marrow  of  bone,  3. 
Mastication,  45. 
Matches,    poisoning   by,    186. 
Medication,   172. 
Membranes,    mucous,    29. 

serous,   29. 

synovial,   25. 
Mercury,   bichloride  of,   218. 
Metacarpal   bones,    18. 

fracture   of,    131. 
Metacarpus,    the,   18. 
Metatarsal   bones,    22. 

fracture    of,    137. 


Milk,    food   valu(>    of,    !.'(»."». 
Moi'phine,     173. 

poisoning   by,    l.S.'i. 
Mouth,  hipniorrhage  of,   110, 
Mucous  memhrani's,   I'O. 
Muriatic  acid,   poisoning  by,    187. 
Muscles,   25. 

atrophy   of,   28. 

involuntary,    28. 

rigidity   of,   at  death,   28. 

voluntary,    25, 
Mushrooms,    poisoning   by,    182. 
Mussels,    poisoning   by,    182, 
Mustard    poultices,    80. 

Narcotic    poisons,    179. 
Necrosis   of   bone,   3. 
Nerves,    63. 

cranial,    64. 

motor,   64. 

sensory,    64. 

spinal,   66. 

sympathetic,    66. 
Nervous    system,    59. 
Nitric   acid,   poisoning  by,    187. 
Nose-bleed,    or    epistaxis,    110. 
Nose,    foreign    bodies   in,    192. 
Nux-vomica,    174. 

poisoning  by,  185. 

CEsophagus,   or   gullet,   47. 
Opium,    173. 

poisoning  by,    183. 
Organ,   definition  of,   28. 
Oxalic  acid,  poisoning  by,    187. 

Padding   for    splints,    125. 
Pancreas,   52. 

function   of,    53, 
Paralysis,    stroke    of,    155. 
Paregoric,    173. 

poisoning   by,    183. 
Paris  green,   poisoning  by,   183. 
Patella,    the,    or   knee-cap,   22. 

fracture    of,    136. 
Pearlash,    poisoning  by,   188. 
Pelvis,    the,    or    basin,    18. 
Pericardium,   34. 
Periosteum,    3. 


228 


PROMPT  AID  TO  THE  INJURED. 


Phalanges,    18,    22. 

dislocation   of,   138. 

fractures    of,    132,    137. 
Pharynx,   or   throat,   47. 

foreign    bodies    in,    193. 
Phosphorus,   poisoning  by,   186. 
Pleura,    42. 

Plugs,  or  tampons,  87. 
Poisoning,  by  acetic  acid,  187. 

by  aconite,  179. 

by  alcohol,  180. 

by  ammonia,  188. 

by  arsenic,   183. 

by  atropine,   180. 

by  belladonna,  180. 

by  camphor,   180. 

by  cantharides,  184. 

by  carbolic  acid,   187. 

by  caustic  potash,   188. 

by  caustic  soda,   188. 

by    chloral,    181. 

by    chloroform,    181. 

by    copper,    184. 

by   corrosive   sublimate,    188. 

by    creasote,    187. 

by   croton-oil,    184. 

by   digitalis,    181. 

by  hydrocyanic  acid,  182. 

by  iodine,   185. 

by   laudanum,    183. 

by   lye,    188. 

by   matches,    186. 

by   morphine,   183. 

by  muriatic  acid,   187. 

by  mushrooms,   182. 

by   mussels,    182. 

by  nitric  acid,   187. 

by   nux-Yomica,    185. 

by    opium,    183. 

by  oxalic  acid,  187. 

by   paregoric,    183. 

by   Paris  green,   183. 

by  pearlash,  188. 

by    phosphorus,    186. 

by  poison   oak   or  ivy,   188. 

by  prussic  acid,   182. 

by    salts   of   lemon   and    sorrel, 
187. 

by   Spanish  fly,    184. 


Poisoning,  by  strychnine,  185. 
by   sulphuric    acid.    187. 
by   tartar  emetic,   186. 
by   zinc,    186. 
treatment  of,   176. 
constitutional,  179. 
local,   by   emetics,    177. 
by   stomach-pump,    178. 
Poison   oak   or   ivy,   poisoning  by, 

188. 
Poisons,    classification   of,   176. 
irritant,    176,   183. 
narcotic,    176,    179. 
Potash,     caustic,     poisoning     by, 

188. 
Poultices,   87. 
bread,    89. 

corn-meal,    89. 
flaxseed,    88. 
hominy,  89.    . 
mustard,    89. 
Prussic  acid,  poisoning  by,  182. 

Radial     artery,     compression     of, 

115. 
Radius,   14. 

Rectal    medication,    175. 
Respiration,    39. 
Ribs,   11. 

fracture  of,  127. 

Salivary  glands,   47. 

Salts     of     lemon,     poisoning     by, 

187. 
Scalds,   143. 

Scalp,    haemorrhage   of,    110. 
Scapula,     or    shoulder-blades,    12. 
Secondary    haemorrhage,     116. 
Secretion,    29. 
Serous   membranes,   29. 
Shin-bone,    or   tibia,    21. 
Shock,    147. 

treatment    of,    148. 
Shoulder  bandages,   78. 
Shoulder-blade,   or  scapula,   12. 
Skeleton,    the,    4. 
Skin,    or   integument,    56. 

appendages  of,   57. 

care   of,   57,   197. 


INDEX. 


229 


Skin,   false,  56. 

functions   of,    57. 

true,    56. 
Skull,   division   of   bones   of,   8. 
Sling   bandages,    81. 
Snake-bite,    treatment    of,    99. 
Sorrel,   poisoning   by,    187. 
Spanish  fly,   poisoning  by,   184, 
Spinal   cord,   62. 
Spine,    the,   6. 

changes   in,   6. 
"  Spitting   of   blood,"    or    haemop- 
tysis,   118. 
Spleen,   58. 

Splint-bone,    the,   or   fibula,    22. 
Splints,    124. 

padding    for,    125. 
Sprains,    139. 

treatment  of,  139. 
Sternum,   the,   11. 
Stomach,   48. 

anatomy  of,   48. 

capacity   of,   48. 
Stroke    of    paralysis,    155. 
Strychnine,    174. 

poisoning  by,   185. 
Stunning,  154. 
Suffocation,   164. 

Sulphur,    as   a   disinfectant,    215. 
Sulphuric     acid,      poisoning     by, 

187. 
Sunstroke,     160. 

treatment   of,   161. 
Sweat-glands,   57, 
Sweet-breads,    52. 
Sympathetic  system,  66. 
Syncope,    151. 

treatment   of,    152. 
Synovial   membrane,   25. 

Tampons,  or  plugs,   87. 
Tarsus,   or   instep,   22. 
Tartar  emetic,  poisoning  by,   186. 
Teeth.   45. 

haemorrhage     following    extrac- 
tion  of,    110. 


Tendons,    27. 

Tetanus,    or   lockjaw,    189. 
Thigh-bone,    or   femur,    19. 
Thorax,    or    chest,    10. 
Throat,  or  pharynx,  47. 

foreign    bodies    in,    193. 
Tibia,  or  shin-bone,  21, 
Toes     (phalanges),     fracture     of, 

137. 
Trachea,   or   windpipe,   39. 

Ulna,    16. 

Ulnar     artery,      compression     of, 

115. 
Unconsciousness,    146. 
Ureters,   54, 
Urine,   54. 

quantity   secreted,   57. 

Veins,  anatomy  of,   38. 

Vertebrae,    the,   6. 

Vertebral    column,    curves   of,   7. 

division   of,    7. 

fracture    of,    127. 
Vesicles,   or   air-cells,    41, 
Vitriol,  oil  of,   poisoning  by,   184. 

Whisky,   99,   110,   173, 
Windpipe,  or  trachea,   39. 
Wounds  caused  by  insects,   100. 

classification    of,    93. 

contused,    95. 

gangrenous,   101. 

gunshot,    93. 

healing  of,  95. 

incised,   93, 

lacerated,    93. 

of  abdominal   walls,    100. 

of    thorax,    100. 

poisoned,    94, 

punctured,    93. 

treatment   of,    96, 
Wrist,  or  carpus,   18. 

Zinc,   poisoning  by,   186. 


THE  END 


(15) 


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